A case management protocol: reducing unnecessary Medicare admissions in Florida.
The Florida Medicare quality improvement organization implemented a case management project with 20 acute care hospitals to reduce unnecessary Medicare admissions. The project called for hospitals to implement a protocol to assign patients to observation or inpatient admission status. Results of the project showed a 67% reduction in the denial rate for the participating facilities. This relative reduction in denial rates was nearly 3 times greater for the participating facilities as compared to the control facilities. The protocol can easily be adopted by hospitals.
Michelman
Mark
M
Florida Medical Quality Assurance, Inc, 4350 W Cypress St, Suite 900, Tampa, FL 33607, USA. mmichelman@flqio.sdps.org
Collier
Patricia
P
Dion
Charles
C
Richards
Ferdinand
F
Ohleyer
Henry
H
Vasey
Paulette
P
Henshaw
Zachary
Z
Davison
Karen
K
D019090:Case Management; D016022:Case-Control Studies; D005431:Florida; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review; D006278:Medicare / Q000592:standards / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000592:standards*; D014481:United States