Column | Healthcare Business Trends

ALOS Analysis Reveals Significant Regional Variances

Column | Healthcare Business Trends

ALOS Analysis Reveals Significant Regional Variances

An analysis of average length of stay looking at U.S. hospitals identified noteworthy variation among states within each of four regions.

An analysis of 2015 data comparing average length of stay (ALOS) among states within various U.S. regions finds notable variances associated with this measure. a

In the Far West, the data indicate that ALOS is 18 percent higher in Nevada than the next highest geographic peer. b This high ALOS is associated with average charge per inpatient admission of $66,778, which is 21 percent higher than that of the next highest peer state in the Far West, and 51 percent higher than the national average of $44,072.

When broken out by payer type, the Nevada data show Medicaid admissions account for 27 percent of the State’s admissions, compared with 23 percent of admissions for the region. The average length of a Medicaid admission (5.19 days) in Nevada is 13 percent higher than the peer average of 4.58 days, with the average charges for the same admissions being nearly 33 percent higher at $53,704.

Meanwhile in the Northeast, New York shows an ALOS that is 5 percent higher than the next-highest ALOS among other states in the region and 11 percent higher than the national average. c With 13 percent of the total admissions in the collected database, and significant variation in New York could affect not only the regional totals but also overall totals for all regions.

Also in New York, in contrast to the Nevada findings, commercial admissions make up nearly 46 percent of the total admissions within the state, which far exceeds the regional figure of 38 percent. Further, that data indicate that New York had more than 1 million commercial admissions, at an average charge of $39,844, which is 5.6 percent higher than the peer commercial charge of $37,748, with the resulting difference exceeding $2 billion.

These results show the differences in hospital populations in various regions and the major differences in health plans both regionally and within various states in the regions. It also is clear from the analysis that there is no one approach to payment results or solutions to rising costs. Rather, hospitals should focus on their own geographic data and circumstances rather than adopting solutions or approaches based on higher-level analyses and results that do not account for regional differences.

Many states collect inpatient admission data from hospitals via organizations such as state agencies, hospital trade associations, and firms that specialize in data collection, and using these data, the states create and make available nonidentifiable data sets for commercial and academic use. The states range from large to small and span the entire length and depth of the country, providing a comprehensive social, ethnic, and geographic base from which comparisons can be made. The analysis that follows draws on the data collected from these states, combined into a single archive of inpatient hospital data for analytic and benchmarking purposes.

Regional Variation in Hospital Average Length of Stay

This research and analysis was prepared by Optum Advisory Services. For more information, contact Jan Welsh at


a. Data from 2015 constitute the most recent data available at the time of this analysis.

b. This information is from the records of the Nevada Division of Healthcare Financing and Policy (DHCFP) and was released through the Center for Health Information Analysis (CHIA) of the University of Nevada, Las Vegas. Authorization to release this information does not imply endorsement of this study or its findings by either DHCFP or CHIA.

c. New York Inpatient Discharge Data source data provided by New York State Department of Health, Bureau of Biometrics and Health Statistics, and the Statewide Planning and Research Cooperative System.

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