Reducing unnecessary admissions related to 1-day stays: a collaborative effort.
OBJECTIVE
To reduce the rate of inappropriate admissions to acute care inpatient prospective payment system hospitals


METHODS
Acute care hospitals.


METHODS
The study involved 3 measurement periods. A statistically valid sample of Medicare discharge claims with a 1-day length of stay (LOS for diagnosis-related groups 132, 141, 143, 182, and 183 was obtained from each participating hospital. Claims with discharge dispositions of 02 (transfers), 07 (left against medical advice), 20 (expired), and 66 (transferred to a critical access hospital) were excluded.


RESULTS
Seventeen acute care hospitals in Indiana collaborated with the quality improvement organization in reducing unnecessary admissions for the focused 1-day LOS admissions. The study resulted in a 2.6% relative improvement from baseline to remeasurement with an estimated overpayment of $1,494,294. In addition, there was a 42.6% decrease from baseline to remeasurement in the total number of claims meeting the study criteria.


CONCLUSIONS
In many instances, case management can impact the following findings: Medical records sampled for this study, focusing on 1-day LOS, lacked documentation to support medical necessity for an inpatient admission. Diagnosis-related groups related to symptoms, such as DRG 143 (chest pain), are at high risk for not meeting admission necessity. The majority of patients admitted to an inpatient stay with complaints of chest pain-like symptoms were admitted through the emergency department. Lack of medical necessity for an acute inpatient admission is a potential risk for denial, impacting the revenue cycle and patient satisfaction. Outpatient observation should be utilized when evaluating an unconfirmed diagnosis.
Helderman
Mary
M
Health Care Excel, Medicare Quality Improvement Organization, Terre Haute, IN 47803, USA. mi_helderman53@hotmail.com
Kraemer
Yvonne L
YL
Dyer
Jo
J
Davis
Holly S
HS
Firestone
Milton
M
D019090:Case Management / Q000706:statistics & numerical data*; D003299:Cooperative Behavior; D006305:Health Status Indicators; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D013997:Time Factors; D014600:Utilization Review