The average length of stay metrics in the Trella Health Hospice Solution are calculated from all claims submitted by the hospice during the standard one year reporting period from the time of patient admission to discharge. The metric is calculated in days.
More detail: The index event would be a discharge claim submitted during the most recent one year reporting period. The reference period for counting the length of stay would be three years. This means that the longest length of stay would be from a patient who was discharged on the last day of the current data set but who was admitted on or before the first day three years back from the end of the current reporting period. This maximum is 1095 days (or 1096 if there is a leap year.) We do not count back past the three year reference period, so any patients who were in hospice care prior to that time will receive a count of the maximum possible days within the reference period.
There are two different length of stay metrics that you will find; ALOS and MLOS. ALOS stands for Average Length of Stay and is a mean average where the total patient days are divided by the total patients. MLOS stands for Median Length of Stay and is the median average where we identify the length of stay that is the center of the data set, that is, there are as many numbers in the overall set below the center number as there are above the center number. When comparing ALOS and MLOS, a large difference between the metrics is indicative of some extreme counts that skew the mean.
Length of stay calculations in the Trella Health Solutions include only patient stays where the patient has been discharged. As a result, length of stay metrics are shorter than in the Solution than what you will find in other data references. For example: a patient who has been in hospice care for over a year, but not discharged, would not appear in our length of stay metrics even though that would extend the length of stay.
With regard to length of stay, financially, hospice providers reach the break even point after providing about three weeks of care. In addition, shorter lengths of stay don't allow the hospice staff to provide the levels of oversight, comfort care and bereavement preparation that are the hallmark of excellent hospice care. With that in mind, an evaluation of length of stay metrics will provide insights into measures that should be taken to improve patient length of stay. Hospice eligibility requirements for Medicare state that a patient be diagnosed with a terminal condition and prognosis of six months or less. Hence, patient stays longer than 180 days are penalized by CMS. The national average for hospice stays is 88 days.
Length of stay metrics do not often suggest an immediate course of action. However, a metric that stands out at the extremes raises good questions and should prompt additional investigation into connected metrics. The following situations are suggestive:
- LOS that is too short
- Trace back to find the physician and facility sources - why are they recommending hospice so late? How can they be helped to properly identify hospice appropriate patients? Are the caregivers taking advantage of the opportunities to encourage hospice care.
- Check out the MDC's for the patients. A hospice with higher percentages of certain MDC's, e.g. cardiac, might make sense to have a shorter overall LOS.
- LOS that is too long
- This could be indicative of a hospice that has an aggressive admission strategy. It is possible that they are at risk for overage penalties.
- Just as with an LOS that is too short, check the MDC's to see if the hospice is caring for a higher population of shorter diagnoses, like cardiac.