In the mid 2000’s, Medicare introduced a remedy for that polarity by instituting a 1% Medicare Fee for hospitals with high 30-day re-admission rates. This new change sent shudders through the hospital industry and those Fees have been increasing over time, meaning hospitals are now pressured to have short length-of-stay and low re-admission rates.
With the new fee, hospitals worked to reduce re-admission rates to avoid the fee—yet, in so doing, most began to notice a commensurate rise in length-of-stay. Failing to join these two vitally important, inter-defendant outcomes then led to increasing resources spent to decrease Length-of-Stay by one team followed by increasing resources for another team to decrease re-admission rates. These competing teams spend more and more and get diminishing returns—in fact they are likely to yo-yo back and forth depending on which one is most successful at any given time.
Instead of stepping back and saying “Length-of-Stay and Re-Admission rates are two sides of the same polarity” that require we think beyond the “hospital box”, the hospital leaders, managers, doctors, nurses and patients are bouncing back-and-forth and draining human and financial resources with limited to no meaningful and sustainable results across both poles.
By identifying the Polarity and managing the Polarity of LOS and Re-Admissions, leaders can begin to look beyond the hospital for home-based and ambulatory efforts to decrease the need to stay in the hospital or be-re-admitted, drawing on a singular empowered and integrated team charged with reducing length-of-stay AND reducing-re-admissions—and finding the required partners to achieve both.
It shifts from an either-or, win-lose competition framework between two rival hospital teams towards a both-and, win-win coopetition across the health system and broader community. Many call this both-and approach Value-Based Care & Population Management which are emerging models to move beyond either-or thinking and win-lose implementation toward integrated navigation of complex polarities across the healthcare sector.
By treating a polarity as if it were a problem with a time-bound solution, hospital leaders are inadvertently creating rising costs with limited sustainable improvement. In some ways hospital leaders need to expand their approach to include ambulatory leaders, care managers, home health experts to establish meaningful partnerships in addressing the length-of-stay and re-admission polarity. It is likely limitations of resources in non-hospital settings that is creating the dependence on hospitals to try to manage LOS and re-admission rates, when many of the factors contributing to increasing length-of-stay and re-admissions occur outside of the domain of the hospital.
Expanding the leadership perspective through partnerships will likely expand the horizons of possible ways for patients and health systems to navigate this challenging polarity. It may also mean hospital leaders may need to invest in non-hospital activities to level the resource capabilities across more areas of healthcare and get payers to support that transition so that a robust ambulatory and home-care system can sustain improvements over time and avoid the bouncing beach ball effect of treating a polarity as if it was a simple problem.
