The $6 million question: can process improvement ensure appropriate hospitalizations?
Short, unnecessary hospitalizations are the largest contributor to erroneous Medicare payment. A team of medical, nursing, case management, and coding and billing professionals used process improvement techniques to reduce inappropriate 1-day admissions among 20 hospitals with high 1-day-stay utilization. Interventions included performance feedback, root cause analyses, process redesign, monthly progress monitoring, and quarterly pattern analyses. Over a 6-month period, the unweighted average admission error rate was reduced from 39% to 21% (p < .01). An estimated 1,396 1-day stays were prevented or denied payment, resulting in an annual savings of $6 million for Medicare's Hospital Insurance Trust Fund.
Chang
Yishih J
YJ
Primaris, Columbia, MO, USA.
Ketterlin
Rita
R
Laiben
Gregg
G
D003953:Diagnosis-Related Groups; D006302:Health Services Research; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data; D006278:Medicare / Q000191:economics*; D017064:Process Assessment, Health Care / Q000379:methods*; D012051:Reimbursement Mechanisms / Q000592:standards*; D014481:United States; D014600:Utilization Review / Q000706:statistics & numerical data