Q&A: Using GMLOS vs. ALOS
Q: I am reaching out to gather insight into the use of geometric length of stay (GMLOS) versus average length of stay (ALOS) in other facilities for clinical, financial, and operational teams. Do you use one over the other, or are both employed by your program for different purposes?
Response #1: At our organization, an interface was created last summer that interfaces the DRG with GMLOS, and CDI specialists update the DRG GMLOS as it evolves to the physician’s EPIC view. Case management and physicians use this for discharge planning. Almost all of our payers use MS-DRG except Medicaid. Medicaid in our state only has ALOS in their table, so for Medicaid, ALOS is used.
Response #2: We use GLOS because the outliers are removed, which then provides a truer comparison or goal for length of stay (LOS).
Response #3: I report GMLOS to leadership and the variances (i.e., GMLOS before CDI and GMLOS after). I have given access to all care managers to utilize this information of the GMLOS and the DRG when looking at the LOS.
Response #4: Our facility compares GLOS to ALOS by physician for all hospitalists. The hospitalist group also has an overall goal, and various teams/actions are put into place to achieve that goal. Most recently, that means each hospitalist meets three times per week with pharmacy, therapy, care management/social work, and nursing teams. Our CDI department was included, but we found that the gain was not worth the time spent.
The team will sometimes reach out about the DRG when the patient is very sick. Often, the patient has multiple MCCs and there is not a way to move to a higher DRG. A lot of the focus of this team is to streamline things to reduce the LOS.
Response #5: Our hospitalist group looks at GLOS for all payers, working to reduce the LOS. We do not monitor financial loss from discharging too quickly, but we are 60% Medicare. We also do not monitor sharing the DRG payment with this particular process. Many of our patients have transferred to a lower level of care. ALOS is rarely lower than GLOS overall. There often are delays due to insurance not approving transfer and the need for guardianship.
Editor’s note: This question was answered by members of the ACDIS CDI Leadership Council. For the purposes of this article, all Council member answers have been deidentified.