Reducing unnecessary medicare admissions: a six-state project.
OBJECTIVE
The Centers for Medicare & Medicaid Services funded a project in six western states to decrease the payment error rate in short-stay admissions (< or =2 days) and decrease the number of inpatient discharges for short stays. Seventeen hospitals were recruited to implement the Case Management Assignment Protocol (CMAP), which standardizes the decision-making process at admission, thereby increasing the number of hospitalized patients assigned to the correct status of inpatient or observation.


METHODS
Acute care hospitals.


CONCLUSIONS
Based on the decrease in unnecessary admissions and the relationship between use of the protocol and correct admission status, the project demonstrated that the CMAP was effective in ensuring that patients were placed in the appropriate status.


CONCLUSIONS
1. Case managers can play a key role in correct assignment of patient status through the use of the CMAP. 2. Hospitals that were successful in implementing the protocol had highly involved senior management, stable corporate environments, physician buy-in, physician champions, policies for mandatory use within the facilities, support from all team members, and "out-of-the-box" thinking for case management coverage. 3. Staffs at hospitals that implemented the protocol indicate they are well positioned for the Recovery Audit Contractor program, which began as a 3-year demonstration project and is now being implemented. It will be in place nationally by 2010.
Romero
Andrea
A
New Mexico Medical Review Association, Albuquerque, NM 87109, USA. aromero@nmqio.sdps.org
Brown
Carlene
C
Richards
Ferdinand
F
Collier
Patricia
P
Jentz
Susan
S
Michelman
Mark
M
Davison
Karen
K
D019090:Case Management / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data*; D009732:Nursing Care / Q000706:statistics & numerical data*; D016730:Program Development; D015397:Program Evaluation; D011445:Prospective Payment System / Q000706:statistics & numerical data*; D012051:Reimbursement Mechanisms / Q000706:statistics & numerical data; D014481:United States; D019564:Unnecessary Procedures