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Top 3 Southern California Hospitals for Highest Super Utilizer Contributions to Revenue and LOS in Los Angeles County

By: Saparja Nag  Nov. 22, 2017

Inpatient data on super utilizers provide critical insight into how these high-risk patients influence revenue and overall length of stay. A full background and methodology on super utilizer contributions can be read here. Using Medicare inpatient data collected between October 2015 and September 2016, the percentages of discharges, unique patients, revenue, and LOS were determined and compared to state and national values. The top 3 hospitals in Southern California by highest percentage of discharges from super utilizers were also the top 3 highest in the region for super utilizer contributions to revenue and LOS.

Southern California Hospital at Hollywood (SCHH) is a 100-bed acute care facility that emphasizes a commitment to community needs. They are known in the area for their work with the LGBTQ community and specialty in gender confirmation surgery. Centinela Hospital Medical Center is over 3 times the size of SCHH with 369 beds. They have a level II emergency department and have been fully accredited by the Joint Commission. St. Vincent Medical Center was Los Angeles’ first hospital in 1856. It is roughly the same size as CHMC with 366 beds and include a number of speciality clinics.

  • Super utilizer contributions to unique patients, discharges, revenue, LOS and 30 day readmissions for California are very similar to values for the nation.
  • Southern California Hospital at Hollywood super utilizers make up roughly 37% of patients but account for about 50% of total discharges, revenue, and LOS. The 4.1% gap between contribution to revenue (50.08%) and LOS (54.18%) may represent an efficiency gap due to super utilizers. This gap stems from a greater super utilizer contribution to days spent in the hospital than the contribution to revenue. Therefore, 4.1% of days spent in the hospital are not accounted for in revenue.
  • Centinela Hospital Medical Center super utilizers accounted for about 23% of the patient population. They were responsible for around 40% of all discharges, revenue, and LOS. Super utilizer contribution to revenue (43.05%) was 0.33% greater than contribution to LOS (42.72%) indicating that total days spent in hospital are proportional with revenue for super utilizers.
  • St. Vincent Medical Center super utilizers made up 18% of patients but contributed about 33% on average to discharges, revenue, and LOS. A gap of 2.35% between contribution to revenue (33.23%) and LOS (35.58%) indicates possibly decreased revenue by 2.35% due to super utilizers.
  • Average super utilizer contribution to 30 day readmissions for California and U.S. were both over 50%. SVMC was less than 10% greater than both state and national values. CHMC had a 28% greater contribution of super utilizers to 30 day readmissions, while SCHH had a 46% greater contribution of super utilizers to 30 day readmission.
  • Revenue, LOS, and 30 day readmissions at SCHH, CHMC, and SVMC are all heavily influenced by super utilizers as contributions to these quality outcomes are much higher than the state and national averages. 

Region% of Unique Patients who are Super Utilizers% Discharges from Super Utilizers% Revenue from Super Utilizers% LOS from Super Utilizers% 30 Day Readmissions from Super Utilizers
Southern California Hospital at Hollywood37.3351.9950.0854.1876.96
Centinela Hospital Medical Center23.2739.7643.0542.7267.46
St. Vincent Medical Center17.9930.9233.2335.5857.38
CA7.5523.725.6729.6953.33
National7.6523.7425.9229.452.05

16.87% of Discharges from The New York-Presbyterian Hospital Are Admitted to Skilled Nursing Facilities, This is Nearly 5% Less Than the National Average

By: Emily Carpintero  Nov. 22, 2017

Skilled nursing facilities (SNF) are optional care facilities for patients discharged from a hospital.  Doctors decide on using an SNF according to whether a patient requires medical experts to assist with care and/or the rehabilitation process.  Using Medicare inpatient data collected between October 2015 and September 2016, Dexur analysts identified Medicare inpatient discharges, discharges to SNFs, and the percentage of SNF discharges at the national, state, and individual hospital level.  

According to Dexur data, the third leading hospital in New York for Medicare inpatient discharge volume between October 2015 and September 2016 was The New York-Presbyterian Hospital in New York City-Weill Cornell Medical Center.  The New York-Presbyterian Hospital is one of the most renowned academic medical centers, internationally.  They  provide high quality, cutting-edge treatments for emergency, primary and specialty care in all departments of medicine.  In 2016, New York Magazine’s Best Doctors listed 1,300 top doctors across all specialties, and 282 of these physicians practice at The New York-Presbyterian Hospital.  

Looking at the table below, the total number of Medicare inpatient discharges, total number of discharges to SNFs, and percentage of SNF discharges are comparable between the nation, New York state, and The New York-Presbyterian Hospital for October 2015 - September 2016.

National, State & Hospital LevelTotal DischargesTotal SNF DischargesSNF Discharge Rate %
U.S. National11,053,5202,151,08919.46%
New York State603,53131,01521.71%
The New York-Presbyterian Hospital14,3392,41916.87%

Nationally, there were over 11,000,000 Medicare inpatient discharges and nearly 20% (2,151,089) were discharged to an SNF.  Looking at New York’s data regarding Medicare patients during that time period, New York surpassed the national average of SNF discharges by 2.25%.  However, The New York-Presbyterian Hospital, serving the greater New York metropolitan area, stayed below both the state and national averages by 4.84% and 2.59%, respectively.  This is remarkable considering their high discharge volume of Medicare inpatients at the national and state levels and the array of services they cover.  Typically, a patient would prefer being discharged to the comfort of their homes over an SNF; the low rate for SNF discharges by this hospital validates their commitment to quality care.

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Hospital for Special Surgery is the Top Ranked Hospital by Medicare Orthopedic Discharge Volume by Treating 40% More Patients than the Nation’s 2nd Highest Volume Hospital

By: Jeffrey Maser  Nov. 22, 2017

In another Dexur article, we addressed the connection between physician discharge volume and quality metrics. We found that although volume alone does not necessarily imply quality, these two factors have a strong positive correlation. Therefore, it is still valuable to understand which physicians in an area account for a large portion of the community’s healthcare. Similarly, it is valuable to understand which hospitals account for high percentages of a community’s discharges.

Dexur data analysts studied hospital discharge volume on national, statewide, and countywide levels for every therapeutic area and specific DRG and the top 10 hospitals for orthopedic discharge volume nationwide for the time period of October 2015 - September 2016 are given below.

RankHospital NameCityState / U.S. TerritoryTotal Medicare Inpatient Orthopedic Discharges% Of National Discharges
All U.S. Hospitals1,364,880100.00
1Hospital for Special SurgeryNew YorkNew York5,5240.40
2Florida Hospital, OrlandoOrlandoFlorida3,9020.29
3Beaumont Hospital - Royal OakRoyal OakMichigan3,6570.27
4Mayo Clinic Hospital, Saint Mary's CampusRochesterMinnesota3,6430.27
5Wilmington HospitalWilmingtonDelaware3,2370.24
6New England Baptist HospitalRoxbury CrossingMassachusetts2,7130.20
7Cedars-Sinai Medical CenterLos AngelesCalifornia2,5570.19
8Morristown Medical CenterMorristownNew Jersey2,5420.19
9New Hanover Regional Medical CenterWilmingtonNorth Carolina2,5120.18
10Virtua Voorhees HospitalVoorheesNew Jersey2,4120.18

As indicated by the above table, between October 2015 - September 2016, Hospital for Special Surgery (HSS) in New York, New York saw over 1,500 more orthopedic discharges more than the next leading hospital in orthopedic discharge volume. The 5,524 discharges from HSS was 41.6% higher than the 3,902 discharges from Florida Hospital, Orlando, which is the next highest volume hospital for orthopedics discharges. Out of the 1,364,880 orthopedics discharges from U.S. Medicare enrollees during the aforementioned timeframe, the discharges from Hospital for Special Surgery accounted for 0.40% of these discharges. With over 5,000 inpatient facilities in the U.S., 0.40% of discharges makes up a significant portion of the market share.

When we look more specifically at the rankings for orthopedic discharge volume for the state of New York alone, these market share values are inherently going to be substantially higher. Between October 2015 - September 2016, Hospital for Special Surgery accounted for nearly 6% of all orthopedic discharges from New York residents enrolled in Medicare. With over 200 hospitals in New York alone, this is a very impressive statistic. For reference, the next highest volume hospital in New York state for orthopedic discharges is North Shore University Hospital, where the discharges there accounted for nearly 3% of New York Medicare enrollees’ orthopedic discharges.

Orthopedic Inpatient Discharge Volume RankHospital NameCityStateTotal Medicare Orthopedic Inpatient Discharges % Of New York’s Orthopedic Discharges
All New York Hospitals66,270100.00
1Hospital for Special SurgeryNew YorkNew York3,7605.67
2North Shore University HospitalManhassetNew York1,9582.95
3Tisch HospitalNew YorkNew York1,9112.88
4St. Joseph's Hospital Health CenterSyracuseNew York1,2141.83
5Montefiore Medical CenterBronxNew York1,1911.80
6St. Peter's HospitalAlbanyNew York1,1261.70
7Long Island Jewish Medical CenterNew Hyde ParkNew York1,0941.65
8NewYork-Presbyterian/Weill Cornell Medical CenterNew YorkNew York1,0731.62
9Albany Medical CenterAlbanyNew York1,0691.61
10Staten Island University HospitalStaten IslandNew York1,0581.60

When we take the number of national orthopedics discharges (5,524) for Hospital for Special Surgery and subtract the number of discharges from New York residents (3,760), we are left with 1,764, which represents the number of discharges at Hospital for Specialty Surgery that came from Medicare enrollees living outside of New York. This means that if only the orthopedic discharges at HSS from out-of-state residents accounted for the hospital’s discharge volume, the hospital would still rank 39th in orthopedic discharge volume.

Hospital for Special Surgery is known as one of the top orthopedic hospitals in the nation and, according to commentary from HSS Surgeon-in-Chief Emeritus, Dr. Thomas Peter Sculco, is the oldest orthopedic hospital in the United States. With that in mind, it is not surprising that a hospital with such an esteemed reputation ranks highest in the U.S. for orthopedic discharge volume among Medicare enrollees. 

About 21% of New Hanover Regional Medical Center’s Revenue is Contributed by 30 Day Readmissions, While the National Average is Nearly 26%

By: Emily Carpintero  Nov. 21, 2017

North Carolina had the 11th highest volume of Medicare inpatient discharges in the nation, accounting for 3.22% of discharges between October 2015 and September 2016.  Along with total Medicare inpatient discharge volume, Dexur analysts identified total Medicare inpatient payments, total percentage of revenue contributed from 30 day readmissions and the percentage of total days from length of stay (LOS) contributing to 30 day readmissions.  You can read about 30 day readmission contribution to revenue and percentage of days from length of stay contributing to 30 day readmissions, as well as how this data is calculated here.  

According to Dexur data, the leading hospital in North Carolina for Medicare inpatient discharge volume between October 2015 and September 2016 was New Hanover Regional Medical Center in Wilmington.  The hospital was founded in 1967 and currently holds several accreditations and national awards.  New Hanover Regional Medical Center has accomplished a five-star rating for knee-replacements every year for over a decade.  It has also been noted that they have high quality care for cardiac arrest patients; they treat these patients 40 minutes faster than the national average.  

Looking at the table below, Dexur analysts identified the percentage of revenue contributed from 30 day readmissions from Medicare inpatients and the percentage of days from length of stay (LOS) contributing to 30 day admissions from Medicare inpatients at the national, state, and hospital level between October 2015 and September 2016.

Hospital NameTotal Medicare Inpatient Discharges Total Medicare Inpatient Payments 30 Day Readmission Medicare Inpatient Revenue Contribution % 30 Day Readmission Medicare Inpatient LOS Contribution %
Total, U.S.10,893,308$122,976,827,09425.72%27.07%
Total, NC350,429$3,597,879,28223.24%24.86%
New Hanover Regional Medical Center17,168 $188,166,67720.57%23.26%

The national hospitals’ average percentage of revenue contribution from 30 day readmissions of Medicare inpatients is 22.48% lower than the national average at 23.24%.  New Hanover Regional Medical Center is below the national and state average for both revenue contribution from 30 day readmissions and the average percentage of days from LOS from 30 day readmissions that contributed to revenue from Medicare inpatients. Its average is 5.15% less than the national average for revenue contributed by 30 day readmissions and 2.67% less than the state average.  New Hanover Regional Medical Center also has a small gap of only 2.66% between their revenue contributed by 30 day readmissions and the average percentage of days from LOS from 30 day readmissions that contributed to revenue.  New Hanover Regional Medical Center was able to treat a high volume and array of patients, while successfully keeping below the national and state averages and minimizing cost for care.

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  1. All categories treated at New Hanover Regional Medical Center with total Medicare inpatient discharges, total Medicare inpatient payments, percent of revenue contributed by 30-day readmissions and the average percentage of days from LOS from 30 day readmissions that contributed to revenue from Medicare inpatients

Connecticut’s 30 Day Readmission Rate to Index Hospital 15% Higher than National Rate

By: Saparja Nag  Nov. 21, 2017

30 day readmission rates to index hospitals are commonly used to measure the continuity of care that patients receive. The metric is often utilized in hospital comparisons to explain differences in quality of care. The state of Connecticut had the highest proportion of readmissions admitted to the index hospital in the country based on Medicare data between October 2015 and September 2016. Dexur’s analysis revealed the 3 Connecticut hospitals with the highest readmission rates to index hospitals were Danbury Hospital, Stamford Hospital, and Yale-New Haven Hospital. A primer on 30 day readmissions to index and non-index hospitals can be found here.

Danbury Hospital, a member of the Western Connecticut Health Network, is a non-profit community hospital. They had 8,007 Medicare discharges between October 2015 and September 2016 while also contributing $143 million to the community. Stamford Hospital is a Level II trauma center that serves Fairfield county, CT and Westchester county, NY, treating 4,453 Medicare discharges during this data time period. Yale-New Haven Hospital is the highest volume hospital in Connecticut with 22,191 Medicare inpatient discharges. They are nationally recognized for patient care, clinical research, and healthcare equality.

  • Danbury Hospital makes up 6.00% of Connecticut’s total inpatient Medicare discharges and has a readmission rate that is 1.21 times the average of Connecticut’s. Danbury Hospital’s emphasis on community care may translate to individualized medical treatment that encourages patients to return to physicians and nurses they know.
  • Stamford Hospital is the smallest of the 3 top hospitals, only accounting for 3.33% of the state’s total Medicare inpatient discharges. The high readmission rate to index hospital for Stamford Hospital may suggest that more personalized and intimate care can encourage patients to return for a readmission visit.
  • Yale-New Haven Hospital Medicare inpatient discharges makes up 16.6% of Connecticut’s total. YNHH was increased 17% from the state average, therefore the quality of care that YNHH is renowned for may play a role in the majority of patients returning when readmission is necessary.
  • These 3 hospitals are located in New Haven and Fairfield counties, which together make up 66.96% of the total Connecticut population despite being only a quarter of the state by area. The proximity to the New York metropolitan area also may play a role in these significant values.
  • Connecticut is a relatively small state with a readmission rate to index hospitals 128% of the national average. The 70.48% readmission rate to index hospitals is the highest of all 50 states. Having 3 hospitals with readmission rates to index hospitals above 80% has a considerable impact on the state average.
RegionTotal Medicare Inpatient Discharges% Readmission Rate to Index Hospital
Danbury Hospital8,007 85.42
Stamford Hospital4,453 83.68
Yale-New Haven Hospital22,191 82.76
CT133,57570.48
National11,053,52055.04

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  • Total Medicare Inpatient Discharges and Readmission Rate to Index Hospitals for all 50 States and Nation

Miami-Dade County is #1 in Florida for Highest Medicare Costs, Hospitalization Rate & Readmission Rate

By: Jeffrey Maser  Nov. 21, 2017

Within a population, hospitalization rates, readmission rates, and average cost per person are all closely related. For a background on hospitalization rates and cost per person, please click here. For purposes of this study, the readmission rate for a population is defined as hospital readmissions divided by total Medicare discharges from the population. When more people are hospitalized, more discharges occur. With more discharges, more people can potentially be readmitted. When more people are admitted and readmitted, more money is paid by Medicare into the total pool. As that total pool of dollars increases, cost per person within the population rises as well. A diagram, which indicates the connections between these three measures can be seen below.

Medicare enrollees within Miami-Dade county, Florida serve as a clear example of these connections. As seen in the table below, Miami-Dade county residents were ranked first in the state for both yearly hospitalization cost per enrollee and inpatient readmission rate while county residents were second in the state for inpatient hospitalization rate, only behind residents of Florida’s Okeechobee County. 

Florida CountyYearly Hospitalization Cost per Enrollee RankYearly Hospitalization Cost per Enrollee ($)Inpatient Readmission Rate RankInpatient Readmission Rate (%)Inpatient Hospitalization Rate RankInpatient Hospitalization Rate (%)
Miami-Dade15,186130.31243.29
Okeechobee24,598229.45148.06
Dixie34,0923823.28341.8
Baker43,9153523.321038.13
Union53,8831724.77441.52
Broward63,877328.31736.26
Putnam73,7963024.011337.57
Columbia83,7801225.43639.16
Suwannee93,716826.23938.21
Duval103,7123623.31738.41

When viewing the Miami-Dade county data on the national level, the data remains significantly higher than average for all three measures. Out of all counties nationwide, Miami-Dade County residents land in the 98th percentile for highest readmission rates, the 97th percentile for highest yearly cost per Medicare enrollee and the 96th percentile for highest hospitalization rates. 

To understand these measures in comparison to counties of similar size, Dexur analysts identified all U.S. counties with an enrolled Medicare population of at least 50,000 people. Within this 159 county subset, Miami-Dade county residents had the second highest readmission rate, the fifth highest hospitalization rate and the sixth highest yearly cost per Medicare enrollee. It is important to organize and analyze county data by population size as large, urban environments may have different patterns than less populated, rural areas. When compared to counties of similar size, the differences in the data for Miami-Dade county residents are even more apparent; Miami-Dade County Medicare enrollees pay more per hospitalization, are admitted more, and are readmitted significantly more than the average U.S. county’s Medicare enrollees.

U.S. CountyStateInpatient Readmission Rate RankInpatient Readmission Rate (%)Yearly Hospitalization Cost per Enrollee ($)Total Medicare Payments for All ($)Inpatient Hospitalization Rate (%)Medicare Enrollments Fee for Service
ClarkNV131.734,015767,788,07729.73191,251
Miami-DadeFL230.315,186828,278,00643.29159,729
LakeIN330.24,997337,721,04944.4167,583
HarrisTX429.734,2021,244,239,16132.15296,076
El PasoTX528.683,254175,743,39029.7754,002
HidalgoTX628.454,566229,678,62938.0750,301
TarrantTX728.373,962553,547,54534.71139,697
BrowardFL828.33,877535,811,88936.26138,204
DallasTX927.663,842820,782,60331.58213,608
CollinTX1027.273,062214,548,55128.0470,063

Renown Regional Medical Center’s Dr. Jackson Brent Jones Performs over 5% of all Hip and Knee Replacements for Nevada Residents

By: Jeffrey Maser  Nov. 20, 2017

Recent data shows that Dr. Jackson Brent Jones, a specialist in orthopedics at Renown Regional Medical Center in Reno, Nevada, accounted for the 6th highest number of discharges under Medicare for Nevada residents from October 2015 to September 2016. Dr. Jones accounted for 239 Medicare discharges for Nevada residents to make up 0.28% of the 84,790 Medicare discharges for Nevada residents during the aforementioned time period (below).

RankPhysician NameTotal Medicare Inpatient Discharges % Of Nevada Resident Total Discharges
All84,790100.00
1Mark Henry Steinhauer4700.55
2Robert J Tait3180.38
3Karyn Rae Doddy3080.36
4Farzin Farhang2870.34
5Snehal Desai2550.30
6Jackson Brent Jones2390.28
7Shahid Wahid2280.27
8Sanjay Nayyar1990.23
9Frank Faris1760.21
10Eric Martin Boyden1740.21

While physician discharge volume alone does not necessarily imply quality of care, it logically follows that a physician who commands a large volume of patients could be treating a high patient volume due to the quality of care associated with their discharges. Therefore, it is still valuable to understand which physicians in a specific community are accounting for a high volume of discharges within the community. A potential additional benefit to seeing a high volume physician for a specific area is that the physician may have more experience with local health issues and could treat such issues more effectively.

While Dr. Jones only ranked 6th in total Medicare inpatient discharge volume for Nevada residents, he ranked second in volume for orthopedic discharges. Out of the 10,569 orthopedics discharges from Nevada residents during the timeframe, Dr. Jones accounted for 223 of these discharges. This gives Dr. Jones a 2.11% share of the orthopedic discharges that were accounted for by Nevada Medicare enrollees during the time period analyzed.

Digging even deeper, we see that Dr. Jones performed the most hip and knee replacements for Nevada residents during the assessed time period (below). Dr. Jones’ 180 hip and knee replacement discharges amount to a 5.13% market share of the 3,510 hip and knee replacements from Nevada residents. This means that about 1 out of every 20 Nevada Medicare enrollees who needed a hip or knee replacement between October 2015 and September 2016 went to Dr. Jones for their procedure. Along with Dr. Jones’ high patient volume, he is also a local pioneer in his field having performed the first outpatient total hip replacement in northern Nevada back in June of 2016. While we must again recognize that volume alone does not necessarily entail quality of care, the data certainly shows that Dr. Jones is a very popular specialty physician for Nevada residents.

RankPhysician NameTotal Medicare Inpatient Hip and Knee Replacement Discharges% Of Nevada Resident Hip and Knee Replacement Discharges
All3,510100.00
1Jackson Brent Jones1805.13
2Robert J Tait1795.10
3Eric Martin Boyden1474.19
4Michael R Edmunds1063.02
5Sanjai Shukla972.76
6Parminder Kang922.62
7Paul Young Shonnard882.51
8Martin Anderson872.48
9James B Manning832.36
10Russell T. Nevins802.28

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

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.

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  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

University of Colorado Hospital and Denver Health Medical Center Super Utilizers Contribute More to Readmissions, Revenue, and Length of Stay than National and State Averages

By: Saparja Nag  Nov. 17, 2017

Super utilizers are a significant subsection of the publicly insured population. Although they only account for about 5%-10% of the combined Medicare and Medicaid population, they are responsible for nearly half of the total cost of public healthcare. The high cost is due to excess emergency department visits and multiple hospital admissions.1 For an introduction to super utilizer analysis, read this article.

Super utilizers in the state of Colorado have lower contributions to readmission rates, revenue, and length of stay than the country as a whole, according to Dexur data analysis. The University of Colorado Hospital, however, has greater contributions to these quality outcomes than the state and the nation. The Denver Health Medical Center has an even greater super utilizer contribution to readmissions and revenue than the University of Colorado Hospital. The one difference between Denver Health and University of Colorado Hospital, however, is the contribution to length of stay. Denver Health super utilizers contribute less than the national average to overall length of stay. This data can be visualized in the graph below.

The Dexur data team was able to determine the percentage of unique patients and total discharges that were super utilizers, those with >3 discharges between October 2015 and September 2016. University of Colorado Hospital had 9,102 total Medicare inpatient discharges in this time frame. Nearly 14% of the unique patients served at this hospital were super utilizers, making up almost 26.5% of all Medicare discharges. Denver Health serves a smaller population, with only 1,706 total Medicare inpatient discharges. However, there was a greater proportion of super utilizers treated in this facility. More than 17% of unique patients at Denver Health were admitted more than 3 times within the year time period, which accounted for nearly 28.5% of all discharges. The analysis is shown below. These statistics can be used to understand the needs of certain populations and communities in order to implement effective super utilizer interventions.

% of Medicare Unique Patients with >3 Discharges between Oct 2015 - Sep 2016% of Total Medicare Discharges with >3 Discharges between Oct 2015 - Sep 2016
University of Colorado Hospital13.91%26.44%
Denver Health Medical Center17.26%28.47%

A study conducted in collaboration with University of Colorado School of Medicine and Denver Health Medical Center studied publicly insured or uninsured super utilizers. They focused on preventative policy initiatives at the community and primary care levels to decrease excessive healthcare costs. They found that although the percentage of super utilizers was relatively constant over time, the individual patients were constantly cycling in and out of super utilizer status month to month. Super utilizer patients often fell into a number of distinct categories: multiple chronic conditions, severe mental health diagnoses, and reported homelessness. These categories could allow for targeted specialized models and intervention programs to address different risk factors, decreasing super utilizer hospitalizations.1

Another study done by Denver Health implemented a team-based intervention program of risk-stratification to provide primary care resources to super utilizers. The program was based in an intensive outpatient clinic specifically targeted towards super utilizers and studied changes in utilization, discharges, and mortality. Unexpectedly total hospitalizations increased, but mortality rates and costs decreased significantly. They found that intensive care unit hospitalizations decreased as well. The results indicated that the quality and intensity of inpatient care, not just the volume of services provided, greatly affect super utilizer hospitalizations 2

References:

  1. Johnson TL, Rinehart DJ, Durfee J, et al. “For many patients who use large amounts of health care services, the need is intense yet temporary.” Health Affairs. Aug 2015; 34(8): 1312-1319. DOI: 10.1377/hlthaff.2014.1186

  2. Durfee J, Johnson T, Batal H, et al. “The impact of tailored intervention services on charges and mortality for adult super-utilizers.Healthcare. Aug 2017; S2213-0764(17)30057-X. DOI: 10.1016/j.hjdsi.2017.08.004.

Florida’s Top 3 High Volume Hospitals’ Length of Stays and Revenues, Post Implementation of Readmission Reduction Programs

By: Emily Carpintero  Nov. 17, 2017

Florida had the 4th highest volume of Medicare inpatient discharges in the nation, accounting for 7.56% of the total between October 2015 and September 2016.  Using Dexur’s data, we were able to determine not only the total number of Medicare inpatient discharges, but also the total Medicare inpatient payments, total percentage of revenue contributed from 30 day readmissions, and the percentage of total days from length of stay (LOS) that comes from 30 day readmissions.  You can read about a general scope of 30 day readmission contribution to revenue and percentage of days from length of stay contributing to 30 day readmissions, as well as how this data is calculated here.  

According to Dexur’s data, the three leading hospitals in Florida for Medicare inpatient discharges between October 2015 and September 2016 were Florida Hospital, Orlando, Baptist Medical Center, Jacksonville and Sarasota Memorial Hospital. Looking at the table below, we were able to analyze the percentage of revenue contributed from 30 day readmissions of Medicare inpatients. We were also able to review the percentage of days from from length of stay (LOS) contributing to 30 day admissions at a national, state and individual hospital level. 

Hospital NameCityStateTotal Medicare Inpatient Discharges (Oct. 2015 - Sep. 2016)Total Medicare Inpatient Payments (Oct. 2015 - Sep. 2016)30 Day Readmission Medicare Inpatient Revenue Contribution % (Oct. 2015 - Sep. 2016)30 Day Readmission Medicare Inpatient LOS Contribution % (Oct. 2015 - Sep. 2016)
Total, U.S.10893308$122,976,827,09425.72%27.07%
Total, FL823506$7,935,916,96027.2%29.17%
Florida Hospital, OrlandoOrlandoFlorida36454$378,225,99527.81%30.35%
Baptist Medical Center, JacksonvilleJacksonvilleFlorida14439$128,656,02724.15%26.32%
Sarasota Memorial HospitalSarasotaFlorida14315$136,116,89123.34%25.45%

  • The national hospital average of revenue contribution from 30 day readmissions of Medicare inpatients was an estimated 26%, while Florida hospital average is an estimated 1.48% higher than the national average.

  • Florida Hospital, Orlando the leading hospital in Florida for Medicare inpatient discharges, was the only hospital of the three above the national and state average for percent of Medicare inpatient revenue contributed from 30-day readmission (2.09% and 0.61%, respectively).

  • Florida Hospital, Orlando’s gap between percentage of revenue contributed from 30 day readmission rates and percentage of days from LOS from 30 day readmissions was 2.54%; this is a slightly high gap, thus impacting the hospital’s overall revenue.

  • Baptist Medical Center, Jacksonville was below the national and state average for both: revenue contributed from 30 day readmission rates and percentage of days from LOS from 30 day readmissions.

  • Baptist Medical Center, Jacksonville was below the national average of revenue contributed by 30 day readmissions by 1.57%, and below the state average by 3.05%.  The gap between revenue from 30 day readmission rates and percentage of days from LOS from 30 day readmissions was 2.17%. 

  • Sarasota Memorial Hospital was also below the national and state average for both categories. This hospital had the lowest percentage of revenue from 30 day readmissions, of the three hospitals, with only a 23.34% contribution rate.  This was 2.38% lower than the national average and 3.86% lower than the state average.

  • Sarasota Memorial Hospital had a 25.24% of days from LOS contributing from 30 day readmissions which held a 2.11% gap from the revenue contributed by 30 day readmissions.

  • After reviewing the Dexur data, it is evident that two of the top three Medicare discharging hospitals in Florida (Baptist Medical Center, Jacksonville and Sarasota Memorial Hospital) were able to stay below the national averages for percentage of revenue contributed from 30 day readmission rates and percentage of days from LOS from 30 day readmissions.  However, the leading hospital of the three (Florida Hospital, Orlando) had over 20,000 more discharges than Baptist Medical Center, Jacksonville and Sarasota Memorial Hospital.  When assessing these averages it’s important to consider volume of patients and the scope of conditions the hospitals are treating.