![]() In other words, a short length of stay receives the same payment as a long length of stay, which presses hospitals to keep stays as short as possible. (“Bed” is a convenient but simplified term, because beds are staffed, equipped, configured and monitored in myriad ways to serve various types of patients and to treat a daunting variety and mix of conditions.)Īnother important development in recent years is the payment policy of the single largest payer of US medical bills – the Centers for Medicare and Medicaid Services, or CMS – which under its Prospective Payment System pays a flat fee for its constituents’ care, determined by their primary diagnosis. ![]() Conversely, the efficient care of a current patient opens a bed sooner rather than later for the next patient in need. Patient access to healthcare is also an important consideration for average LOS, because a current inpatient occupies a bed that will eventually serve a next inpatient, and by extension, a current patient’s unusually long length of stay may delay a next patient’s opportunity for care. This macro-level calculation enables management to forecast various expenses, notably the staffing requirements and costs associated with total inpatient care. To better understand the financials of inpatient length of stay, it is important to note that average LOS is an essential component of budgeting hospital “production”, used to derive the number of inpatient encounter-days a hospital expects to manage within a given period. Part 2, in other words, suggests that a less frustrating way forward for hospital leadership – whether corporate or local – is to first get in touch with the operations management practices of its clinical frontline, a gesture of operational empathy. At their core, these target-setting methodologies are the same as those used by the most competitive operations leaders across myriad industries, and Part 2 also explores how a bias toward accounting and finance in hospital management has undermined best-practice operations management. Part 2 focuses on smarter target setting and demonstrates how clinical bedside teams currently deploy effective methodologies in their own professional domains, enabled and tested by decades of research and engineering. ![]() Such targets and tools align closely with the values and perspectives, say, of the board, but they do not resonate at the bedside, and so a mutual frustration ensues. ![]() Part 1 of The Macro and Micro of Hospital Length of Stay asserted that bedside clinical teams are often handed targets and tools for the management of length of stay (LOS) – an important indicator of hospital efficiency – that are ineffective. ![]()
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