Download or read book Controlling Costs and Changing Patient Care written by Institute of Medicine and published by National Academies Press. This book was released on 1989-01-01 with total page 321 pages. Available in PDF, EPUB and Kindle. Book excerpt: Utilization management (UM) has become a strong trend in health care cost containment. Under UM, some decisions are not strictly made by the doctor and patient alone. Instead, they are now checked by a reviewer reporting to an employer or other paying party who asks whether or not the proposed type or location of care is medically necessary or appropriate. This book presents current findings about how UM is faring in practice and how it compares with other cost containment approaches, with recommendations for improving UM program administration and clinical protocols and for conducting further research.
Download or read book Utilization Management of Acute Care Services written by Sandra Wiggins and published by . This book was released on 1988 with total page 462 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book An Introductory Guide to Utilization Management for Acute Care Facilities agencies written by British Columbia Health Association and published by . This book was released on 1991 with total page 30 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Utilization Management in an Acute Care Hospital written by Constance Montgomery and published by . This book was released on 1995 with total page 582 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book The Hospital Guide to Contemporary Utilization Review written by Stefani Daniels and published by . This book was released on 2015-04-16 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Hospital Guide to Contemporary Utilization Review is a comprehensive resource designed to identify utilization review (UR) best practices and provide guidance on developing and enhancing a contemporary UR committee. This book focuses on the latest UR and patient status requirements to help hospitals perform high-quality reviews and comply with regulations. The book covers a range of topics, including compliance with the UR Condition of Participation, legal obligations of a hospital, contract language, and compliant UR plan language to provide an understanding of the expectations of a UR program. Tips for intradepartmental collaboration are included to guide professionals through the process of selecting a physician advisor and partnering with nurses, case managers, and revenue cycle team members. This book will help you do the following: Identify the components of a best practice hospital utilization review (UR) program Describe the legal obligations of the hospital to comply with chapter 42 CFR 482.30 of the Conditions of Participation (CoP) Use the publication as a tool to assess his or her own hospital's UR processes Summarize the benefits of a dedicated UR team to promote compliance with the CoP Facilitate the development of a contemporary UR committee Assess an organization's opportunities to improve processes to benefit patient care and hospital success Recommend compliant language for the organization's UR plan Construct commercial contract language, in collaboration with the organization's contract manager, that promotes a partnership to ensure appropriate use of acute care resources Seek out operational resources to perform high-quality reviews that fully comply with the CoP Explain the connection between a good utilization review plan and the hospital revenue cycle initiatives
Download or read book Health Care Utilization as a Proxy in Disability Determination written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2018-04-02 with total page 161 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.
Download or read book Mistahia Health Services Utilization Project written by Cathryn Bradshaw and published by . This book was released on 2001 with total page 64 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Improving Healthcare Quality in Europe Characteristics Effectiveness and Implementation of Different Strategies written by OECD and published by OECD Publishing. This book was released on 2019-10-17 with total page 447 pages. Available in PDF, EPUB and Kindle. Book excerpt: This volume, developed by the Observatory together with OECD, provides an overall conceptual framework for understanding and applying strategies aimed at improving quality of care. Crucially, it summarizes available evidence on different quality strategies and provides recommendations for their implementation. This book is intended to help policy-makers to understand concepts of quality and to support them to evaluate single strategies and combinations of strategies.
Download or read book Retooling for an Aging America written by Institute of Medicine and published by National Academies Press. This book was released on 2008-08-27 with total page 316 pages. Available in PDF, EPUB and Kindle. Book excerpt: As the first of the nation's 78 million baby boomers begin reaching age 65 in 2011, they will face a health care workforce that is too small and woefully unprepared to meet their specific health needs. Retooling for an Aging America calls for bold initiatives starting immediately to train all health care providers in the basics of geriatric care and to prepare family members and other informal caregivers, who currently receive little or no training in how to tend to their aging loved ones. The book also recommends that Medicare, Medicaid, and other health plans pay higher rates to boost recruitment and retention of geriatric specialists and care aides. Educators and health professional groups can use Retooling for an Aging America to institute or increase formal education and training in geriatrics. Consumer groups can use the book to advocate for improving the care for older adults. Health care professional and occupational groups can use it to improve the quality of health care jobs.
Download or read book The CMS Hospital Conditions of Participation and Interpretive Guidelines written by and published by . This book was released on 2017-11-27 with total page 546 pages. Available in PDF, EPUB and Kindle. Book excerpt: In addition to reprinting the PDF of the CMS CoPs and Interpretive Guidelines, we include key Survey and Certification memos that CMS has issued to announced changes to the emergency preparedness final rule, fire and smoke door annual testing requirements, survey team composition and investigation of complaints, infection control screenings, and legionella risk reduction.
Download or read book A Comparison of Two Utilization Review Methods in an Acute Care Setting written by Keith Kelley and published by . This book was released on 1996 with total page 54 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Mistahia Health Services Utilization Project written by Corrine Truman and published by . This book was released on 2001 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Utilization Review Software written by Kimberly Annette Frazier and published by . This book was released on 2014 with total page 92 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Center for Medicare and Medicaid (CMS) seeks to achieve cost control by implementing aggressive cost containment mechanisms for an exploding Medicare population. One such mechanism is utilization review, which is employed to limit reimbursement of medical care that is determined to not be medically necessary. The CMS Conditions of Participation mandate that all hospitals determine whether a patient qualifies for an Inpatient or Observation stay. Utilization Review Specialist (UR) nurses were given the Conditions of Work Effectiveness Questionnaire II (CWEQ-II), Organizational Relationship Scale II (ORS-II), and the Job Activity Scale II (JAS II), six months after McKesson InterQual software was installed. The CWEQ-II resulted in the following scores: Opportunity x = 0.83, Information x = 0.71, Support x = 0.91, Resources x = 0.42. Descriptive statistics revealed that the UR nurses perceive themselves to be moderately empowered as measured by the CWEQ-II total score of 14.92 (SD + 1.23). The Net Present Value was calculated as $1,619,677.93 over a four-year span. Medical necessity denials have increased significantly over the past several years and continue to place hospitals in financial jeopardy. By providing employees with appropriate computer software programs, hospitals can mitigate the monetary damages associated with this particular denial and recoupment, and improve nurse satisfaction and commitment. Empowering work conditions for specialty nurses have positive effects on organizational attitudes and behaviors.
Download or read book The Healthcare Science and Innovation of Treating Acute Medical Conditions in the Optimal Management Strategy written by Jared J Conley and published by . This book was released on 2014 with total page 126 pages. Available in PDF, EPUB and Kindle. Book excerpt: Background: The U.S. healthcare system is currently in a state of transformation as efforts are being made to improve clinical outcomes and patient experience while addressing affordability. There is an emerging science that we have a great opportunity to redesign the system in a way that optimizes the match between the care delivery setting of choice and the acute health need of the patient--avoiding the misuse of high-cost settings, such as a hospital inpatient unit and the emergency department (ED).Methods: This thesis was structured to use three methodological tools to investigate the optimal setting of care for acute medical conditions to further enable a more efficient and patient-centered healthcare system. A systematic review was completed to better characterize the literature of treating acute medical conditions without inpatient management. Subsequently, a conceptual framework was developed to elucidate the critical success factors (CSFs) that enable these conditions to be treated in alternative acute care delivery settings (outpatient, hospital-at-home, or observation unit)--with the aim of assisting in the determination of feasibility for other conditions which might qualify as well. Finally, we quantitatively investigated the association between primary care access and ED utilization amongst Medicare beneficiaries using multivariate linear regression techniques, as well as temporal trends in ED use from 2008-2012. Results: Our systematic review demonstrated a moderate level of evidence that it was safe and effective to utilize an alternative acute care delivery setting for over 20 acute medical conditions traditionally treated with inpatient management. The development of the conceptual framework generated a practical, structured model outlining 16 CSFs that were classified into a six category schema to enable effective clinical redesign in this arena. The quantitative analysis showed an increasing trend in ED utilization amongst the Medicare population, but that efforts to improve the percent of beneficiaries visiting their primary care clinician at least once per year would not attenuate this trend.Conclusion: There exists a real opportunity to redesign the U.S. healthcare system in its use of inpatient care and more optimally care for acute medical conditions that qualify for treatment without inpatient management. In addition, ED utilization is increasing amongst older adults and efforts must be made to create stronger links to preventive care delivery systems to allow the ED to be used most efficiently.
Download or read book Rationalizing Acute Care Services written by Pauline Mistry and published by CRC Press. This book was released on 2018-04-19 with total page 133 pages. Available in PDF, EPUB and Kindle. Book excerpt: Rationalization is concerned with making the most effective use of the resources available. In many places where this process is taking place it is plagued with public opposition and misunderstanding. Hitherto rationalization in the acute care sector has primarily been concerned with closing sites closing beds moving beds between services and moving beds from one site to another. This book discusses the need for rationalization in the context of health service reforms and future strategy. It considers recent changes in the health service the case for rationalization health care needs the role of public relations the future of the acute care hospital site and facilities appraisal and the costs of rationalization. The text is essential reading for managers and clinicians involved in acute care services non-executive members of boards and trusts and students of health services management.
Download or read book The Future of the Public s Health in the 21st Century written by Institute of Medicine and published by National Academies Press. This book was released on 2003-02-01 with total page 536 pages. Available in PDF, EPUB and Kindle. Book excerpt: The anthrax incidents following the 9/11 terrorist attacks put the spotlight on the nation's public health agencies, placing it under an unprecedented scrutiny that added new dimensions to the complex issues considered in this report. The Future of the Public's Health in the 21st Century reaffirms the vision of Healthy People 2010, and outlines a systems approach to assuring the nation's health in practice, research, and policy. This approach focuses on joining the unique resources and perspectives of diverse sectors and entities and challenges these groups to work in a concerted, strategic way to promote and protect the public's health. Focusing on diverse partnerships as the framework for public health, the book discusses: The need for a shift from an individual to a population-based approach in practice, research, policy, and community engagement. The status of the governmental public health infrastructure and what needs to be improved, including its interface with the health care delivery system. The roles nongovernment actors, such as academia, business, local communities and the media can play in creating a healthy nation. Providing an accessible analysis, this book will be important to public health policy-makers and practitioners, business and community leaders, health advocates, educators and journalists.
Download or read book Closing the Quality Gap written by Kaveh G. Shojania and published by . This book was released on 2004 with total page 7 pages. Available in PDF, EPUB and Kindle. Book excerpt:
