Despite what might be described as gains in the treatment of patients hospitalized with sepsis, the diagnosis of this potentially life-threatening complication remains one of the single largest opportunities for reducing length of stay for inpatients. Sepsis or severe sepsis was among the 10 highest avoidable day-contributing DRGs (diagnostic related groups) at more than 99 percent of hospitals analyzed in a recent study performed by The Claro Group. The healthcare consulting firm analyzed 2014 data for both traditional and managed Medicare cases at over 70 acute care hospitals across the United States, with the goal of identifying trends in avoidable days. In addition to sepsis, four other DRGs were among the 10 highest in avoidable days contributed at over half of the hospitals reviewed: DRGs 291 (heart failure and shock), 853 (infectious and parasitic diseases), 003 (ecmo or trach), and 292 (heart failure and shock with complications and comorbidities).
DRGs 291 and 292, heart failure and shock groupings with and without major comorbid conditions respectively, ranked second and fifth in the analysis. Ninety-one percent of analyzed hospitals had significant avoidable day opportunity related to DRG 291, while just over half of analyzed hospitals saw significant avoidable day opportunity in DRG 292. It's no surprise that heart failure is a major focus of CMS in controlling Medicare expenditures. Heart failure DRGs represent the largest cause of hospitalizations among Medicare beneficiaries and are among the costliest to Medicare.
DRG 853, an infectious and parasitic disease grouping that could include illnesses such as HIV, tuberculosis, and chickenpox, was a top 10 avoidable day-contributing DRG at 76 percent of hospitals analyzed.
DRG 003, a ventilator support grouping that is one of only two DRGs to carry an expected length of stay of over 25 days, still saw significant avoidable day opportunity at 66 percent of hospitals.
Beyond the frequency with which specific DRGs were found to considerably contribute to avoidable days, Claro's analysis further highlighted the extent that a small total number of DRGs at a hospital influenced that hospital's total avoidable days. Though the DRGs varied across the population analyzed, the 30 DRGs that contributed the most avoidable days at each hospital were responsible for 45 percent of the hospital's total avoidable days.
These findings illuminate the need for coordinated length of stay reduction programs both in the acute care and ambulatory settings, which addresses care management, patient flow and care variation. Focusing on every single DRG to completely eliminate avoidable days is a large challenge; however, by intently focusing on a small number of recognized DRGs, a hospital can significantly impact its number of excess days.