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Hospital cuts: 'down to the bone and muscle.' (editorial)

Hospital cuts: "Down to the bone and muscle"

Two recent cyclical changes are having a profound effect on laboratorians.

The first development is the apparent bottoming-out of average length of patient stay at the nation's hospitals. This decade's decline in length of stay ended in 1986, according to preliminary data from the Department of Health and Human Services.

The second development is related to the first: Demand for clinical laboratory services is exceeding the supply of laboratory personnel. For a comprehensive examination of the critical staff shortage and possible solutions, I refer you to our cover story (page 28) by Bettina Martin. This column will focus on the length of stay trends.

A study conducted by HHS's National Center for Health Services Research and Health Care Technology Assessment found that the average hospital stay dropped from 7.35 days to 5.71 days, or 22.3 per cent, between 1980 and 1985 (see Figure 1). Medicare's switch to nationwide prospective payment provided the initial downward push. But Dean E. Farley, Ph.D., the agency health economist who directed the study, said: "The surprising finding was that privately insured patients also had a sharp decline in their hospital stays."

It was not too surprising, however, in light of what the study saw contributing to a shorter length of stay: changes in reimbursement methods; technological advances; growing reliance on outpatient treatment; greater Government and private third-party payer scrutiny of the need to hospitalize patients; the spread of health maintenance organizations, which have incentives to reduce hospital use; and price competition among hospitals.

"There was a lot of fat in this industry," Dr. Farley said. "We ma have reached the point where we're getting down to the bone and muscle."

Michael Bromberg, executive director of the Federation of American Health Systems, a group of private hospitals and health care organizations, said quality had not declined during the reduction in hospital stays. He added: "The trend is over. Patients in hospitals are more intensely ill than before, and the length of stay is starting to go up again."

The American Hospital Association also had preliminary data that indicated the length of stay decline began to reverse slightly in 1986 and 1987. "Anytime you get as sharp a change as we had, in as short a time, one would expect it to bottom out," Alexander Williams, a senior vice president of the association, commented.

Other findings in the HHS report merit mention. The average hospital occupany rate dropped from 69.7 per cent in 1980 to 56.6 per cent in 1985, and the mean number of beds per hospital fell from 216 to 204 over the same period.

The data paint a picture of retrenchment that challenged laboratorians, compelling many to pick up additional responsibilities and workload as staffs grew smaller, while driving others into new careers. Now we seem to be entering a cycle of expansion, and the key questions are: How quickly and how well can laboratory management adjust to the change?
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Author:Fitzgibbon, Robert J.
Publication:Medical Laboratory Observer
Article Type:editorial
Date:Jul 1, 1988
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