HOSPITAL STAYS: Trimmed to the Limit, May Creep Back Up
Oregon has some of the nation's shortest average hospital stays, but they are beginning to lengthen, a trend that bodes ill for hospitals across the nation eager to trim expenditures. The AP/Eugene Register-Guard reports that $358.5 billion was spent on hospital care in 1996 -- 34.6% of total medical expenditures that year. Oregon's average hospital length of stay (ALOS) hit an all-time low in 1997 -- 3.8 days -- only to climb back up to 3.9 days last year, according to the American Hospital Association (3/8). Should hospital days continue to inch up, the Portland Oregonian reports, "businesses and consumers could be in for renewed escalation of health care costs." HCIA Inc. consultant Jean Chenoweth said, "This is the beginning of a major trend that will spread across the United States. ... The managed care organizations who have experienced losses in the last year or two probably were feeling this already."
'Sicker than Ever Before'
As hospitals worked over the last decade to rein in hospital expenditures by shortening ALOS, they prompted a "profound shift in the severity of cases that hospitals see: As a group, hospital patients are sicker ... than ever before because of the success of efforts to treat less serious cases on an outpatient basis." Portland orthopedic surgeon Dr. Gregory Irvine explained that as refinements in anesthesia and surgical techniques make shorter hospital days possible, "there is a limit." For example, the 48-hour course of intravenous antibiotics for post-op patients and the federally mandated minimum stays for new mothers are non-negotiable. And although new technologies slash hospital stays, they also entice more patients to opt for elective surgery. Industry leaders are at odds over the best strategy to keep costs down: some name administrative costs as the next target for budget cuts, while others insist that hospitals still have unused beds. "Most hospitals have devoted resources to quality improvement, but I think they are still in the earliest stages," said Dr. Steven Freedman of William M. Mercer Inc. He argued "patient care practices are still rife with errors and unnecessary duplication. This is a vast, largely uncharted area with the most promise for containing costs" (Rojas-Burke, 3/8).