Deb Evans is the MVC Site Engagement Manager
Hospital members from the Michigan Value Collaborative (MVC) and the Michigan Arthroplasty Registry Collaborative Quality Improvement (MARCQI) met in a series of two workgroups discussing how to combat unnecessary skilled nursing facility (SNF) admissions following both hip and knee replacement surgery. The primary goals of these workgroups were to identify root causes and initiatives preventing a SNF admission in which the stay provided no value to the patients. At the April MVC semiannual meeting, attendees heard briefly about how participating hospitals designed their initiatives and measured their results. A comprehensive toolkit will be available later this week to all MVC members summarizing the robust discussions and innovative ways to reduce unnecessary SNF use.
You must be a MVC participant to download the toolkit, which will be posted on the data registry (https://mvc.arbormetrix.com/Registry/login ) under the Resources section by Friday, May 19th . You may also email firstname.lastname@example.org and request a copy.
The time a patient is hospitalized, known as the length of stay, can have a big impact on the cost of the healthcare episode as well as an effect on the readmission risk for that patient. There are many studies in the literature discussing the effect of length of stay, its effect on the readmission risk and the costs associated with the healthcare episode. A brief review of recent findings is presented here:
In one study, the authors reviewed whether the day a surgery was performed on would affect length of stay – and thus the overall episode cost. They concluded that surgeries for primary total Hip and total Knee arthroplasty performed later in the week were more likely to have an increased length of stay. Interestingly, only primary total knee arthroplasty occurring later in the week had increased total charges.
A second study reviewed the affiliation between length of stay and readmission risk for total joint arthroplasty, and concluded that an increased length of stay was associated with a higher risk for a 90-day readmission.
Another study looked at patients undergoing colorectal surgery, and discussed the benefits of an enhanced recovery program to help shorten the length of stay while also helping to reduce the readmission rates. They found that within length of the study, they were able to reduce the median length of stay and readmission rates through the development and implementation of an enhanced recovery program.
Finally a recent study performed by Dr. Scott Regenbogen (MVC co-director) and colleagues looked at whether discharge protocols and shorter lengths of stays decreased overall episode costs, or if there were post discharge costs involved that unintentionally increased costs. This study concluded that hospitals able to reduce postoperative length of stays in colorectal, CABG, and total hip replacement service lines were consistently able to reduce payments for the surgical episode.
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