January 15, 1999

Volume is high, admissions and outpatient visits are increasing, and the research program is flourishing, James J. Mongan, MD, MGH president, told hospital managers and department heads at a Jan. 13 leadership meeting. Yet the MGH faces challenges in the new year to reduce its length of stay (LOS), which has been higher than expected, and to continue to tighten its fiscal belt.

According to Mongan, the increase in LOS was a key factor in causing an operating loss of $4.1 million for the first two months of FY'99. Patient days were significantly over budget, which drove expenses higher without additional revenue and reduced capacity for other inpatient admissions.This difficult news comes after a FY'98 operating surplus of $25 million, which was slightly less than the budgeted surplus of $28.4 million.

LOS, which had been budgeted at 6.2 days, was nearly seven days in October and November. While it has decreased somewhat in December, it is still significantly over budget.

According to Mongan, leadership and staff have been seeking the specific causes of the LOS increase. "By getting a handle on our length-of-stay issues, we should be able to stanch the bleeding and look into ways to make a transfusion to catch up to where we should be in our budget cycle," said Mongan.

Leadership groups have convened since October to diagnose the causes of the LOS increase, which include hospital operational delays (waiting for tests, imaging studies, echocardiograms and other treatments such as physical and occupational therapy), post-acute placement delays (delayed transfers to home care and rehabilitation programs) and physician practice patterns.

Remedies to these problems have already been implemented or are in the planning stages. Such efforts include increasing access to MRIs and CT scans (see related stories: Opening of new MGH imaging facility in Chelsea and Mobile MRI begins operation); reviewing and changing scheduling of echocardiograms and therapy sessions; facilitating the transition of patients between the MGH and post-acute-care facilities such as Spaulding Rehabilitation Hospital; and evaluating management of patient care with physician practices.

Mongan concluded by saying that he hopes the recent changes will bring LOS down to 6.5 or 6.4 days this month. "We have met challenges such as this before, and we can do it again," said Mongan.

At the leadership meeting, Mongan also discussed other key issues that senior management has identified as priorities for 1999, such as information systems, prospects for a new ambulatory building, customer service enhancements, continuous Operations Improvement initiatives, and the continued broadening of diversity and culturally competent care throughout the hospital.

The meeting concluded with a presentation by Sally Millar, RN, director of Clinical Support Services, about the new Maxwell and Eleanor Blum Patient and Family Learning Center to be opened in March.