Targeting Length of Stay to Improve Value in Otolaryngology

Introduction: Health care reimbursement practices have transitioned from standard fee-for-service models to value-based practices, emphasizing optimization of patient-based health outcomes while limiting cost. In this setting of variable patient populations, hospital reimbursement is based on the complexity of our patient’s comorbidities through risk adjustment. A major driver of patient outcome and cost, length of stay, is measured against an expected LOS metric known as geometric length of stay (GLOS). This study explores the improvements in performance through changes in documentation and healthcare delivery practices from 2017 to 2022.

Methods: All inpatient otolaryngology (ENT) admissions to a tertiary care academic hospital from January 2017 through March 2022 were analyzed retrospectively. All elective admissions were included. Admissions were categorized based on subsite, date of admission, and diagnosis related group (DRG) with associated GLOS. This was compared to the patient’s actual LOS. Descriptive statistics were used to assess performance against case mix index (CMI) and GLOS by subsite and by year.

Results: Of the 2,393 admissions, 67% were oral cavity and larynx subsites. In 2017, the oral cavity >65 subgroup, patients stayed 0.37 days beyond their GLOS. However, in 2022, they were discharged home 0.95 days earlier than their expected GLOS (a net 1.32 day improvement in 5 yrs). Similarly, improved LOS performance was observed in the laryngeal subsite admissions (1.1 net days earlier), and oropharyngeal admissions (4.2 net days earlier). In 2017, ENT cost exceeded hospital reimbursement. In 2018 the cost to reimbursement ratio equalized and began to show savings in 2019. Since 2020 improvement in DRG and LOS has resulted in a savings to our hospital system totaling $487,400.

Conclusions: In this challenging healthcare environment, hospital systems must explore ways to optimize patient outcomes while limiting healthcare costs. At our tertiary care hospital improvement in documentation and length of stay resulted in significant cost savings.