1. The $6 million question: can process improvement ensure appropriate hospitalizations?
- Author
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Chang YJ, Ketterlin R, and Laiben G
- Subjects
- Diagnosis-Related Groups, Health Services Research, Hospitalization statistics & numerical data, Humans, Length of Stay statistics & numerical data, United States, Utilization Review statistics & numerical data, Hospitalization economics, Length of Stay economics, Medicare economics, Process Assessment, Health Care methods, Reimbursement Mechanisms standards
- Abstract
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.
- Published
- 2008
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