Does Shortening Length of Stay Reduce or Shift Costs?
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(Boston, Mass.) — Hospitals may be saving money because coronary artery bypass surgery (CABG) patients are being discharged sooner, but surgeons from Boston University School of Medicine and Boston Medical Center have shown that costs are actually being shifted to other health care providers. Because CABG patients subsequently utilize outpatient nursing services and extended care facilities upon discharge from the hospital, or are quickly readmitted to the hospital, what appears to be cost savings is actually cost shifting.
These findings were presented today by Harold Lazar, MD, professor of cardiothoracic surgery at Boston University School of Medicine and a cardiothoracic surgeon at Boston Medical Center, at the 80th Annual meeting of the American Association for Thoracic Surgery, in Toronto, Canada.
Lazar and his colleagues compared patients who had undergone CABG surgery in 1990, when protocols to reduce length of stay were not in place with patients operated on in 1998 when these protocols were utilized. Despite the fact that the 1998 patients were sicker and had increased risk factors, they spent less time on ventilators and less time in the hospital—an average of 3.8 days less than those operated on in 1990. However, fewer 1998 patients were discharged to their homes. A higher percentage of these patients were discharged to extended care facilities—43 percent in 1998 compared with only 3 percent of patients in 1990. In addition, patients operated on in 1998 were five times more likely to be readmitted to the hospital than those operated on in 1990.
“While protocols to reduce length of stay have resulted in earlier home discharge for good risk patients, it has also resulted in an increased utilization of ancillary services and extended care facilities for patients who cannot be discharged home,” said Lazar. “Although it is entirely appropriate to utilize extended care facilities for patients who cannot be discharged home in a timely fashion, these facilities may actually consume more health care resources than in the hospital setting. Thus health care dollars hospitals saved from these patients are actually being spent by other health care agencies,” he adds.
Lazar recommends that in order to really decrease costs instead of simply shifting them, fast track protocols and critical pathways which have been so successful in reducing length of stay in a hospital setting, need to be instituted in extended care facilities.
In addition to Lazar, Carmel Fitzgerald, RN, MS, Tazeen Ahmad, AB, Yusheng Bao, MD, Oz Shapira, MD and Richard Shemin, MD, from the department of cardiothoracic surgery at Boston Medical Center and Boston University School of Medicine also contributed to this paper.