title: Reducing unnecessary admissions related to 1-day stays: a collaborative effort.
abstract: 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.
authors.affiliation: Health Care Excel, Medicare Quality Improvement Organization, Terre Haute, IN 47803, USA. mi_helderman53@hotmail.com
authors.forename: Mary
authors.initials: M
authors.lastname: Helderman
authors.forename: Yvonne L
authors.initials: YL
authors.lastname: Kraemer
authors.forename: Jo
authors.initials: J
authors.lastname: Dyer
authors.forename: Holly S
authors.initials: HS
authors.lastname: Davis
authors.forename: Milton
authors.initials: M
authors.lastname: Firestone
mesh_terms: 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