Medicaid Inpatient Psychiatric and Detoxification Utilization and 1 more...less...

Clinical Services Team: Quality Improvement & Clinical Integrity Unit

Average length of stay (LOS) for DVHA inpatient mental health & detox admissions

9.3SFQ1 2021

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Notes on Methodology
                                   
  Average Length of Stay for DVHA Inpatient Mental Health & Detox Admissions  
      SFY 19   SFY 20
(as of 10/13/2020)
  SFY 21
(as of 10/13/2020 )
 
  Q1 Q2 Q3 Q4 YTD   Q1 Q2 Q3 Q4 YTD   Q1  
  Adult # admits 298 276 188 186 948   213 182 90 59 544   130  
  # days auth 2141 2103 1359 1277 6880   1435 1177 614 466 3692   1005  
  Avg LOS 7.2 7.6 7.2 6.9 7.3   6.7 6.5 6.8 7.9 6.8   7.7  
 
  Detox # admits   74 64 44 54 236   33 43 27 13 116   45  
  # days auth 397 284 170 276 1127   161 201 137 77 576   247  
  Avg LOS 5.4 4.4 3.9 5.1 4.8   4.9 4.7 5.1 5.9 5.0   5.5  
 
  Children # admits   68 85 41 17 211   31 41 9 5 86   69  
  # days auth 647 781 377 156 1961   492 484 144 171 1291   1025  
  Avg LOS 9.5 9.2 9.2 9.2 9.3   15.9 11.8 16.0 34.2 15.0   14.9  
 
  Total # admits   440 425 273 257 1395   277 266 126 77 746   244  
  # days auth 3185 3168 1906 1709 9968   2088 1862 895 714 5559   2277  
  Avg LOS 7.2 7.5 7.0 6.6 7.1   7.5 7.0 7.1 9.3 7.5   9.3  
                                   
Partners
  • Vermont Medicaid Inpatient Providers
  • Department of Children & Families
  • Department of Mental Health
Story Behind the Curve

As a part of DVHA’s utilization management program, the Quality Unit impacts and tracks the average length of inpatient psychiatric and detox stays for Vermont Medicaid members over time.

The Utilization Review (UR) Clinicians conduct numerous utilization management and review activities to ensure that quality services, those which increase the likelihood of desired health outcomes and are consistent with prevailing professionally-recognized standards of medical practice, are provided to members and that providers are using the program appropriately, effectively and efficiently. The UR Clinicians utilize clinical criteria for making utilization review decisions that are objective and based on sound medical evidence.

The data in the above trend lines show relatively consistent average lengths of stay for the non-Level 1 DVHA-managed psychiatric adult and detox populations. In January of 2017, UR Clinicians began participation in weekly status calls for all children placed in the Brattleboro Retreat. In doing so, some disposition issues were addressed. This may have contributed to the decrease in the average length of stay for children.

A pilot project with one of our providers was initiated in SFY18 Q1.  We anticipate this pilot to have an effect on the average lengths of stay.

Last updated:  10/15/2020

Strategy

The UR Team regularly shares data with providers that may impact the average lengths of stay. Recently a trend to avoid discharges (especially for children) on weekends was noticed and shared with those providers. Both have reported investigating and one has suggested there might be an internal shift to support daily discharges.

The UR Team has worked closely with providers to provide information on admission criteria. Site visits, presentations, and consultations have shown to improve understanding of requirements. The process has also strengthened our partnerships.

Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy