To the Editor.

The recent article by Sills et al¹ asks whether the recent Milliman and Robertson (M&R) Health Status Improvement and Management (HSIM) publication² presents realistic length-of-stay criteria. The article does not directly answer the question posed. Faculty members in the Department of Pediatrics at the University of Texas at Houston provided contributions to the M&R HSIM, with the intention as stated by the authors "of focusing on best practice rather than median performance." Even with best practice in mind, inspection of the histograms presented in Fig 1 demonstrates that the goal LOS was in fact modal in at least half of the 16 diagnoses. Reanalysis of the published data (Table 1) shows that the average of the "percentage of patients with LOS > M&R" for the 16 diagnoses equals 63%; thus, on average, 37% were discharged on or before the M&R . . . [Full Text of this Article]