Part $1$

Your present length of stay on Medicare patients is $6\mathrm{.}3$ days for $2,000$ Medicare admissions. This value is unadjusted for case$-$mix effects. You have discovered that a normal length of stay should have been $5\mathrm{.}0$ days. If this level had been realized, you would have had $2,600$ fewer days of care for Medicare patients. You are trying to determine the amount of actual savings that would be realized if the shorter length of stay could be achieved. You have been told that a shorter length of stay would affect only direct costs of nursing. Your present direct cost of nursing per day is $$300.$ Some of this cost is considered fixed and would not be changed. If $60\%$ of the nursing cost were considered variable, how much savings would be realized through the length of stay reduction?

Part $2$

Operating margins in your hospital have been consistently below national norms for the past $3$ years. Discuss the factors that might have created this situation and the ways in which you might determine specific causes. include $3$ references