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DOES SHORTENING LENGTH OF STAY REDUCE OR SHIFT COSTS?
30 April 2001 - Boston University
| Hospitals may be saving money because coronary artery bypass surgery patients are being discharged sooner, but surgeons from Boston University School of Medicine and Boston Medical Center have shown that costs are actually being shifted to other health care providers. Because CABG patients subsequently utilize outpatient nursing services and extended care facilities upon discharge from the hospital, or may be readmitted to the hospital, what appears to be cost savings is actually cost shifting. These findings appear in the April 27, 2001 issue of The Journal of Thoracic and Cardiovascular Surgery. |
Hospitals may be saving money because coronary artery bypass surgery patients are being discharged sooner, but surgeons from Boston University School of Medicine and Boston Medical Center have shown that costs are actually being shifted to other health care providers. Because CABG patients subsequently utilize outpatient nursing services and extended care facilities upon discharge from the hospital, or may be readmitted to the hospital, what appears to be cost savings is actually cost shifting. These findings appear in the April 27, 2001 issue of The Journal of Thoracic and Cardiovascular Surgery. Researchers from Boston University School of Medicine compared patients who had undergone CABG surgery in 1990, when protocols to reduce length of stay were not in place with patients operated on in 1998 when these protocols were utilized. Despite the fact that the 1998 patients were sicker and had increased risk factors, they spent less time on ventilators and less time in the hospital-an average of 3.8 days less than those operated on in 1990. However, fewer 1998 patients were discharged to their homes. A higher percentage of these patients were discharged to extended care facilities-43 percent in 1998 compared with only 3 percent of patients in 1990. In addition, patients operated on in 1998 were five times more likely to be readmitted to the hospital than those operated on in 1990. "While protocols to reduce length of stay have resulted in earlier home discharge for good risk patients, it has also resulted in an increased utilization of ancillary services and extended care facilities for patients who cannot be discharged home," said lead author Harold Lazar, MD, professor of cardiothoracic surgery at Boston University School of Medicine and a cardiothoracic surgeon at Boston Medical Center. "Although it is entirely appropriate to utilize extended care facilities for patients who cannot be discharged home in a timely fashion, these facilities may actually consume more health care resources than in the hospital setting. Thus health care dollars hospitals saved from these patients are actually being spent by other health care agencies," he added. Lazar recommends that in order to really decrease costs instead of simply shifting them, fast track protocols and critical pathways which have been so successful in reducing length of stay in a hospital setting, need to be instituted in extended care facilities.
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Boston University has a well-deserved reputation for excellence in research in a wide range of disciplines and a demonstrated commitment to fostering innovative interdisciplinary research. The Office of the Associate Provost for Research and Graduate Education supports the University in facilitating research at the both the student and faculty levels.Our mission is to enhance and encourage research at Boston University and to provide a climate conducive to maintaining the University at the cutting edge of research and scholarly activities. We work with the Boston University community to plan and coordinate interdisciplinary research and represent the University in research matters related to Inter-University consortia. To encourage new, innovative, and cross-disciplinary efforts, this office administers the Special Program for Research Initiation Grants (SPRInG). We showcase graduate research at Science & Technology Day. This annual event features nearly 200 research posters by graduate students from both the Medical and Charles River Campuses working in a wide range of disciplines. Our annual research magazine, Research at Boston University, informs a wide audience about a selection of our significant research findings and ongoing studies at Boston University. We also maintain a strong presence on the web through this site and through the Science Coalition’s website, which brings our research successes to the attention of Congress and other policy makers in the federal government. To assist Boston University researchers, this office oversees the Undergraduate Research Opportunities Program and coordinates with the Office of Sponsored Programs on the Charles River Campus , the research administration on the Medical Campus, the Office of Research Compliance, and the various graduate programs. For the development of commercially viable ideas, we administer the Provost's Innovation Fund and work closely with the Office of Technology Transfer. We also coordinate proposals where there are institutional limits to the number of proposals that may be submitted, cost sharing requirements, significant laboratory renovations, or other special circumstances. This office assists departments and centers to achieve a diverse faculty and graduate student body through our membership and activities with the Northeast Alliance for Graduate Education and the Professoriate and through our affiliation with the Clare Boothe Luce program of the Henry Luce Foundation. |
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