As we, and hospitals like us throughout Massachusetts and the nation, continue to struggle with the challenge of demanding financial times, it is important for us to recognize the impact we can have in our own areas of the healthcare system.
One of these critical areas relates to the average length of stay (ALOS). ALOS at BWH is determined by a variety of factors, such as the case mix index, occupancy rates, the number of available beds at extended care facilities, lab results processing, the innovative use of Faulkner Hospital and a variety of other clinical issues.
To date in FY ’01, the hospital’s case mix index has remained level relative to prior years, implying that the intensity of the care we are providing, as reflected by DRG’s, is roughly equivalent. However, at the same time, our ALOS has increased by four percent. While there are a multitude of drivers of this phenomenon, there are many opportunities we can explore to directly reduce ALOS and greatly impact the hospital’s performance. We must assume responsibility for addressing those factors within our control. Each 0.1 day if backfilled completely translates into 86 additional discharges per month or approximately $864,000 per month. Ten million dollars per year is serious money, and at present, we are 0.7 days over budget.
We continue to assess ways in which we can impact these challenges from a systematic perspective. The Faulkner Hospital/HVMA relationship is one strategic initiative to allow us to address the key components of CMI and census levels. We are also working hard to address the discharge process at the hospital to create space for more patients. And, last month we opened five new ICU beds on 11C to help address this demand.
We need your help. To the extent we can bring ALOS back to budgeted levels, the more successful we can be at achieving the minimal margin targets necessary to meet the mandates of our mission. We will continue to fight for increased reimbursements from Medicare, Medicaid and other third party payers, but in the meantime, we must be equally dedicated to making sure we work diligently to minimize those expense drivers within our span of control.
Chief Medical Officer