Reducing unnecessary medicare admissions: a six-state project.

Area of Science:

• Healthcare Management
• Patient Flow Optimization
• Quality Improvement in Hospitals

Background:

• Short-stay admissions (< or =2 days) present challenges in accurate patient status assignment.
• Payment error rates and inappropriate discharge numbers are significant concerns for healthcare payers like CMS.
• Standardizing admission decision-making is crucial for efficient hospital operations.

Purpose of the Study:

• To decrease the payment error rate in short-stay admissions.
• To reduce the number of inpatient discharges for short stays.
• To increase the accuracy of patient status assignments (inpatient vs. observation) using a standardized protocol.

Main Methods:

• Implementation of the Case Management Assignment Protocol (CMAP) in 17 acute care hospitals across six western states.
• CMAP standardizes the decision-making process at the time of patient admission.
• Focus on improving the assignment of inpatient or observation status for hospitalized patients.

Main Results:

• The project demonstrated a decrease in unnecessary admissions.
• A clear relationship was observed between the use of CMAP and the correct assignment of patient status.
• Hospitals effectively using CMAP showed improved patient status accuracy.

Conclusions:

• The Case Management Assignment Protocol (CMAP) is effective in ensuring appropriate patient status assignment.
• Successful implementation requires strong leadership, physician engagement, and supportive policies.
• Hospitals using CMAP are better prepared for programs like the Recovery Audit Contractor (RAC).