The effects of managed behavioral health care utilization review on hospital substance abuse detoxification.
Four groups drawn from patients in a hospital substance abuse detoxification unit were compared to determine if staff training on the basics of managed care would impact the length of the hospital stay authorized by private health insurance providers. Pre- and post-intervention groups were drawn from patients carrying the most frequently used insurance, Blue Cross/Blue Shield (BC/BS) and from patients of all other private insurance providers. Results indicate that the most frequently used provider was authorizing lengths of stay consistent with those of other private providers. However, results also indicated that significantly shorter lengths of stay were being authorized by all of the private insurance providers during the post-intervention period of the study. This study (1) confirms clinical observations showing a trend toward shorter lengths of hospital stays for patients with substance use disorders and (2) confirms that these decisions are being made primarily by insurance providers.
Gray
M C
MC
School of Social Work, University of Maryland at Baltimore 21201-1777, USA.
D054598:Blue Cross Blue Shield Insurance Plans; D005568:Forms and Records Control; D006282:Health Personnel / Q000193:education; D006801:Humans; D007318:Inservice Training; D007342:Insurance Benefits; D007373:Interinstitutional Relations; D007902:Length of Stay; D008329:Managed Care Programs; D010344:Patient Advocacy; D012948:Social Work Department, Hospital; D016320:Substance Abuse Treatment Centers / Q000458:organization & administration*; D014481:United States; D014600:Utilization Review