Massachusetts General Hospital Medicare Inpatient LOS Outlier Discharges are 6% More than National Average



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By: Saparja Nag  Nov. 20, 2017

Length of stay outliers are discharges that had a much longer than LOS than the average. The percentage of LOS outlier discharges is assessed on a national DRG-level, meaning that the length of stay for each procedure is compared to the same procedures performed around the country. Since the DRG accounts for the risk and case mix index, the threshold for outliers are risk-adjusted for the case mix index. The Dexur data team calculated this metric for each CMS-reporting hospital, state, and the U.S. A background on LOS outliers and methodology for data collection can be read here.

Massachusetts General Hospital is a nationally recognized hospital and has the highest volume of Medicare inpatient discharges in Massachusetts. They also have the largest hospital-based research program, receiving the most research funding from the National Institutes of Health (NIH). With an annual research budget of over $850 million, they were recognized by Nature for publishing the most articles in high-impact journals out of all U.S. hospitals between March 2016 and February 2017. 

Nearly every specialty at Mass General had a greater percentage of LOS outlier discharges than the state and national averages, except for psychiatry. Across all categories, Massachusetts had a lower percentage of LOS outlier discharges than the national average with the exception of cardiovascular, psychiatry, and spine. All of this data can be seen in the table below.

Percentage of LOS Outlier Discharges by Category for Massachusetts General Hospital, Massachusetts, and U.S. 

CategoryMassachusetts General HospitalMassachusettsNational
All Inpatient18.3411.7412.14
Cardiovascular22.3512.5912.02
Colorectal12.711.2312.45
Dermatology23.869.4112.96
Endocrinology25.6210.6912.01
Gastroenterology16.549.4410.69
General Medicine21.1611.1412.55
General Surgery13.6110.2512.26
Neurology16.915.4115.85
Obesity, Bariatric, Stomach & Duodenal9.718.389.07
Obstetrics & Gynecology12.349.9910.64
Oncology & Hematology18.3211.8912.57
Orthopedics16.1210.0410.59
Psychiatry13.216.6214.85
Pulmonology19.9610.9811.62
Spine23.5812.2710.97
Urology16.349.4110.93

So, how is it possible that a nationally recognized hospital has a higher LOS outlier rate than the national average? One possible explanation could be that the patients Mass General is treating are sicker but they are not being appropriately coded to the right DRG. For example, the LOS outlier limit for DRG 470 (joint replacement without major complications & comorbidities) is 5 or more days, given that the average LOS for DRG 470 is 2.9 days in the Medicare population. Mass General has 11.88%, 4.53% more than than the national average of 7.35%, of discharges that are 5 or more days. Could these 4.53% of patients have been coded more appropriately so that they fall in a more severe DRG such as DRG 469 which is joint replacement with major complications & comorbidities with an average LOS of 6.89 days?

Days in hospital are a critical economic and quality lever in hospital management. A deeper understanding of LOS outliers helps hospitals better understand clinical and economic value.

DEXUR PRO MEMBERS GET ACCESS TO:

  1. LOS outlier data for top DRGs at Massachusetts General Hospital
  2. Comparisons of DRGs at Massachusetts General Hospital to state and national values
  3. Percentage contribution of DRG to total discharge volume

ABOUT THE AUTHOR

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Saparja Nag

Saparja is a healthcare journalist with a particular interest in how medicine can and should affect health policy. She has extensive experience as a health educator and research scientist in biochemistry. She also enjoys running, cooking elaborate meals, and then eating elaborate meals. Saparja received a Bachelors of Arts in Biochemistry from Vassar College.