Length of Stay Benchmarks
Improve Performance with Length of Stay Benchmarks
Business issues:
Length of Stay (LOS) considerations are complex, but managed-care providers must understand them in order to make appropriate care-related decisions quickly and effectively. Although every patient is unique, each group of patients has statistical similarities that payers can analyze in asking themselves:
- Which LOS norms are appropriate to use in pre-certifying or pre-authorizing plan members?
- Can we identify cost savings by analyzing our LOS data retrospectively?
- What significant trends can we see by comparing against external norms?
Identify cost-savings opportunities. Solucient's LOS norms allow managed care companies, third-party administrators and Medicare and Medicaid providers to compare actual LOS with regional, national and patient-specific norms based on real experience. Use the data, available by ICD-
9-CM procedure code or diagnosis-related groups (DRG) and for specific payers and populations, to assist in areas such as utilization review, case management and benefit plan administration. "Apples-to-apples" comparisons with specific payers and populations help identify cost savings.
Base decisions on real experience. Built from the largest empirical database of its kind,
our LOS norms use no clinical panel assumptions. Solucient's are the only norms based on actual experience, encompassing more than 20 million inpatient discharges a year. Annual releases allow you to trend experience and performance over time.
Set new standards for improvement. Solucient's benchmarks are the most comprehensive available. They include specialty norms (DRG, pediatric, psychiatric, commercial payer only, geriatric, Medicare, Medicaid and worker's comp) at regional or national levels. Because the benchmarks are provided for DRG and ICD-9-CM procedure codes at the 10th through 99th percentile, you can continuously set new LOS standards to improve performance over time.
See results: Solucient's LOS benchmark files can be used as stand-alone reference tools or integrated seamlessly into your decision support system. Either way, they enhance your reimbursement review, as well as determination and adjudication and claims processing, allowing you to move confidently and efficiently in making pre-certification decisions and developing future strategies.
Insight: Benchmarking data help manage costs and identify trends
A national insurance company had no external national and regional benchmarking data, and relied on the experience of their case managers when determining the appropriate number of patient days to authorize for their 2 million HMO members.
After using Solucient's Length of Stay benchmarks database for pre-authorization and pre-certification, they were surprised to find they could save an average of 0.5 hospital days for pneumonia cases, based on a national average at the 50th percentile. When they compared this to the Western and commercial payer norms, the results were even better. Based on their 2 million members, they estimate they have saved over $500,000 this year on just this single condition.
By looking at age-specific geriatric and Medicare LOS norms, they were also surprised to find that after years of rising LOS, the utilization data was trending toward lower lengths of stay, especially in the South.
| 
