Average Length of Stay and Skilled Nursing Facility Discharge Rate have Positive Correlations of 0.59 and 0.57 for Joint Replacement and Respiratory Failure, Respectively
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By: Jeffrey Maser Dec. 13, 2017
Dexur’s recent analysis of 2016 inpatient Medicare discharges found a significant correlation between average length of stay (LOS) and skilled nursing facility discharge rate for DRG-470 (Major Joint Replacement or Reattachment of Lower Extremity Without Major Complication or Comorbidity) as well as DRG-189 (Pulmonary Edema and Respiratory Failure). A standard correlation test ran between average LOS and SNF discharge rate for DRG-470 returned a value of 0.59 and the relevant value returned for DRG-189 was 0.57. These two values indicate that both correlations assessed here are moderate and positive, suggesting that increased patient length of stay may be associated with higher skilled nursing facility discharge rates.
The Dexur study analyzed the top 20 DRGs by discharge volume for U.S. Medicare enrollees between January and December of 2016. Hospitals were only included if they accounted for 11 or more discharges for each DRG. Although a moderate, positive correlation was found between average length of stay and skilled nursing facility discharge rate for DRG-470 and DRG-189, this was not a common trend across all DRGs. Out of the 20 major DRGs analyzed, only the two aforementioned DRGs were found to have a moderate positive correlation and only two others were found to have a weak, positive correlation.
Although the two correlations along DRG-470 and DRG-189 are certainly significant, skilled nursing facility discharge rates are likely affected more by patient population than by DRG. Patient population health across different regions can vary widely, therefore slightly different approaches may be taken by healthcare professionals in different regions in order to accommodate these variations. Dexur analysts examined SNF discharge rates for the entire U.S. along four of the DRGs included in this analysis and found that regional differences seemed to separate populations more than a patient’s average LOS. For example, along DRG-470, Connecticut and Rhode Island had the highest SNF discharge rates at 41.15% and 39.45%, respectively, while Alaska and Wyoming had the lowest rates at 5.18% and 11.38%, respectively, indicating over a 35% difference between the highest and lowest states’ rates. Overall, although there seems to be a relationship between average length of stay and skilled nursing facility discharge rate for two specific DRGs, this does not seem to be the common pattern across the majority of conditions.
| Correlation between Avg. LOS and SNF Discharge Rate for the Top 20 Highest Volume DRGs in the U.S. between January - December 2016 | |||||
|---|---|---|---|---|---|
| Degree of Correlation Rank | Diagnosis Related Group | Avg. LOS (Days) | SNF Discharge Rate (%) | Correlation between Avg. LOS and SNF Discharge Rate | National Discharges at DRG Level |
| 1 | 470: Major Joint Replacement Or Reattachment Of Lower Extremity Without Major Complication Or Comorbidity | 2.89 | 32.64 | 0.59 | 481,979 |
| 2 | 189: Pulmonary Edema And Respiratory Failure | 8.20 | 25.61 | 0.57 | 111,248 |
| 3 | 885: Psychoses | 11.91 | 19.29 | 0.32 | 125,370 |
| 4 | 190: Chronic Obstructive Pulmonary Disease With Major Complication Or Comorbidity | 5.00 | 20.30 | 0.29 | 74,297 |
| 5 | 378: G.I. Hemorrhage With complication Or Comorbidity | 3.74 | 19.36 | 0.26 | 62,416 |
| 6 | 871: Septicemia Or Severe Sepsis Without Mv >96 Hours With Major Complication Or Comorbidity | 6.46 | 28.83 | 0.25 | 541,617 |
| 7 | 945: Rehabilitation With complication Or Comorbidity/Major Complication Or Comorbidity | 12.81 | 21.47 | 0.25 | 7,393 |
| 8 | 603: Cellulitis Without Major Complication Or Comorbidity | 4.09 | 22.57 | 0.24 | 48,259 |
| 9 | 872: Septicemia Or Severe Sepsis Without Mv >96 Hours Without Major Complication Or Comorbidity | 4.52 | 25.54 | 0.22 | 104,359 |
| 10 | 193: Simple Pneumonia And Pleurisy With Major Complication Or Comorbidity | 5.53 | 27.29 | 0.18 | 91,310 |
| 11 | 392: Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Major Complication Or Comorbidity | 3.26 | 12.61 | 0.16 | 63,313 |
| 12 | 641: Miscellaneous Disorders Of Nutrition, Metabolism , Fluids And Electrolytes Without Major Complication Or Comorbidity | 3.34 | 27.34 | 0.13 | 40,104 |
| 13 | 191: Chronic Obstructive Pulmonary Disease With complication Or Comorbidity | 4.20 | 19.33 | 0.11 | 17,646 |
| 14 | 683: Renal Failure With complication Or Comorbidity | 4.10 | 26.77 | 0.11 | 100,306 |
| 15 | 194: Simple Pneumonia And Pleurisy With complication Or Comorbidity | 4.16 | 24.29 | 0.11 | 56,684 |
| 16 | 682: Renal Failure With Major Complication Or Comorbidity | 5.90 | 32.01 | 0.09 | 92,328 |
| 17 | 690: Kidney And Urinary Tract Infections Without Major Complication Or Comorbidity | 3.54 | 31.62 | 0.08 | 112,107 |
| 18 | 292: Heart Failure And Shock With complication Or Comorbidity | 4.22 | 20.85 | -0.06 | 102,511 |
| 19 | 291: Heart Failure And Shock With Major Complication Or Comorbidity | 5.49 | 24.26 | 0.05 | 229,871 |
| 20 | 065: Intracranial Hemorrhage Or Cerebral Infarction With complication Or Comorbidity Or Tpa In 24 Hours | 4.02 | 30.17 | -0.02 | 79,497 |
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- Total Inpatient Discharges, Total SNF Discharges, Average LOS, and SNF Discharge Rate for all U.S. States, Puerto Rico, and Washington D.C. along the three highest volume DRGs for Medicare enrollee inpatient discharges
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