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3 A novel approach to setting goals to achieve a reduction in acute-care length of stay
  1. Amy D Bell,
  2. Ed Dunlow,
  3. Gary Little
  1. Atrium Health


Background Length of stay (LOS) can be used to measure cost savings when expressed in terms of opportunity days. Using simple tools to assess the percent of contribution for opportunity days by facility and service line, along with a financial target and standard proxy cost per day, LOS goals can be established for the number of opportunity days to save for each facility and service line within a healthcare system.

Objectives Utilize percent of opportunity day contributions to set acute care facility and service line targets based upon a financial goal for a healthcare system.

Methods Targets for LOS opportunity days to save are determined based upon the proportion of the financial goal each facility is expected to contribute to the overall cost savings. An opportunity day is defined as the difference between the number of days a patient stays in the hospital versus the number of days they were expected to stay, determined by Care Science risk adjustment (figure 1). Opportunity days to be saved were translated into an Observed/Expected (O/E) Ratio target for each facility (figure 2).

Results LOS reduction efforts resulted in days saved in non-COVID patients, but the negative savings from COVID patients resulted in a net loss of opportunity days when all patients were bundled together (figure 3). Calculations for opportunity days saved were modified to account for the decrease of inpatient volumes and subsequent analysis of the data included stratification for the COVID vs. non-COVID population.

Conclusions The model described for combining a financial goal by facility with opportunity days enables the setting of LOS targets for healthcare systems. Further, the model supports tracking progress to targets, including the ability to compare specific patient types, e.g., COVID-19 Positive vs. COVID-19 Negative (figure 4).

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