Overview

The average length of stay metrics in Marketscape for Hospice are calculated from all discharge claims submitted by the agency during the standard one year reporting period from the time of patient admission to discharge. The metric is calculated in days.

 To get the average, we add up the count of days from all eligible stays and divide by the number of stays.

More detail

The index event would be a discharge claim submitted during the most recent one year reporting period. The reference period for counting the length of stay would be up to three years. This means that the longest length of stay would be from a patient who was discharged on the last day of the current data set but who was admitted on or before the first day three years back from the end of the current reporting period. This maximum is 1095 days (or 1096 if there is a leap year.) We do not count back past the three year calculation period, so any patients who were in hospice care care prior to that time will receive a count of the maximum possible days within the reference period.

Example:

The skinny red rectangles represent the hospice stays. As long as the discharge (D/C) occurs during the one year reporting period, we count back up to three years to get a length of stay in days.

The yellow represents our standard reporting period, the period from which we gather our index events; in this case, discharges from home health. This one-year period aligns with the end of our current data set. That is, if the most recent data set end with 2019-Q3, this reporting period ends in the same quarter.

The blue is our counting period - we go back three years from the end of the reporting period to count the full length of stay for patients discharged during the reporting period. To be counted, start of care must be in this period. As you can see from the image, a stay can begin and end within the entire 3 year period.

 Length of stay calculations in the Marketscape include only patient stays where the patient has been discharged. As a result, length of stay metrics might be shorter in Marketscape than what you will find in other data references. For example: a patient who has been in post-acute care for over a year, but not discharged, would not appear in our length of stay metrics even though that would extend the length of stay average.

Significance

With regard to length of stay, financially, hospice providers reach the break even point after providing about three weeks of care. In addition, shorter lengths of stay don't allow the hospice staff to provide the levels of oversight, comfort care and bereavement preparation that are the hallmark of excellent hospice care. With that in mind, an evaluation of length of stay metrics will provide insights into measures that should be taken to improve patient length of stay. Hospice eligibility requirements for Medicare state that a patient be diagnosed with a terminal condition and prognosis of six months or less. Hence, patient stays longer than 180 days are penalized by CMS. The national average for hospice stays is 88 days.

Usage

Length of stay metrics do not often suggest an immediate course of action. However, a metric that stands out at the extremes raises good questions and should prompt additional investigation into connected metrics. The following situations are suggestive:

• LOS that is too short
  • Trace back to find the physician and facility sources - why are they recommending hospice so late? How can they be helped to properly identify hospice appropriate patients? Are the caregivers taking advantage of the opportunities to encourage hospice care.
  • Check out the Diagnostic Categories for the patients. A hospice with higher percentages of certain diagnoses, e.g. cardiac, might make sense to have a shorter overall LOS.
• LOS that is too long
  • This could be indicative of a hospice that has an aggressive admission strategy. It is possible that they are at risk for overage penalties.
  • Just as with an LOS that is too short, check the Diagnostic Categories to see if the hospice is caring for a higher population of diagnoses that tend to result in long stays.

Trended ALOS

On the Analyze page for facilities there is a table named, Trended Readmit Rate. This table includes four quarters of length of stay data that we calculate in the same way, with one exception. The reporting period from which we look for home health discharges is a quarter rather than from the entire year.

To get the trended quarters, we look at each quarter in our one year reporting period for discharges within the quarter. We then look back through a three year counting period that aligns with the end of the quarter. As you can see from the image below, we offset the beginning of the counting period to make the quarterly metrics comparable.

 The above image only shows two quarters. The earlier two quarters will offset the three year period even further.