Using a physician-aligned case management model to influence hospital length of stay and payer denials.
The need for physician-hospital alignment is increasingly important with evolving managed care relationships among physicians, health plans, and hospitals. A 310-bed community hospital implemented a physician-centric case management model in October 1999 due to the increasing pressure from managed care to lower hospital lengths of stay, payer denial rates, and overall costs. The medical-surgical inpatient population was chosen as the study group for examining the influence of the new model. Comparative data on average length of stay and payer denied days were reviewed pre- and postimplementation of the new model. The analyzed results showed a decrease in the number of payer-denied days by nearly one third with a relatively stable average length of stay.
Jaques
Susan E
SE
Case Management Department, San Antonio Community Hospital, Upland, California 91786, USA. Sjaques@sach.org
D019090:Case Management; D018578:Hospital-Physician Relations; D006764:Hospitals, Community / Q000458:organization & administration*; D006801:Humans; D019458:Insurance Coverage; D007902:Length of Stay; D008329:Managed Care Programs; D017146:Models, Organizational; D013781:Texas