Half of hospital days avoidable. (Short Takes: News at Deadline).

According to Milliman & Robertson's Hospital Efficiency Index, more than 53 percent of all Medicare inpatient hospital days were potentially avoidable in 1997. The report's indices measure how efficient an individual hospital is relative to the actual length of stay and admission experience of the most efficient hospitals. The researchers say that the U.S. Medicare average length of stay could be reduced from 6.6 to 4.1 days if all care was provided at the most efficient levels, and admissions could be reduced by nearly 38 percent

John Cookson, the M&R Principal who compiled the indices, said. "The 53 percent figure is based on potentially avoidable days to longer than necessary inpatient lengths of stay, and treatments that could have been provided outside the acute hospital environment." There were significant regional differences in the potential savings. At 40 and 41 percent, respectively, Washington and Utah were found to have the smallest potential reduction in Medicare days. Mississippi at 65 percent and New York at 63 percent had the highest potential savings.

Aetna Announces Independent External Reviews

Aetna U.S. Healthcare has announced plans to become the first national managed care organization to voluntarily provide for the external review of coverage decisions. Under the new policy, members of any Aetna U.S. Healthcare plan will have the right to appeal coverage denials to neutral, independent physician reviews.

The company plans to have the external review arrangements in place by June 30,1999 for those plans not already covered by external review legislation. Aetna already offers its members what it says is a comprehensive and thorough internal review of coverage decision The addition of external reviews should give its members more confidence that they won't be denied needed medical care. Expedited external reviews will be available when a member's life, health, or ability to regain maximum function would be in jeopardy if a decision were not rendered before the 60 day period elapses. The insurer will bear the cost of the external reviews.

While Aetna may be making progress in dealing with consumer concerns, it apparently needs to address unrest among its contracting physicians. A 600-member physician group, the San Mateo County Individual Practice Association Medical Group, has dropped out of Aetna, contending that the HMO's reimbursement rates are too low.

James A. Hawkins is Publisher of Healthcare Briefings, a newsletter available in print on cassette, via fax, and on computer disk, He can be reached at 800/338-5486.