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Utilization review altered to advantage

D E Brown, J D Levy

    Hospitals
    |March 1, 1980
    PubMed

    Insights

    Professional Standards Review Organizations (PSRO) exempted the first five hospitalization days from utilization review, leading to significant cost savings and increased concurrent review. This demonstrates an effective healthcare management strategy.

    Area of Science:

    • Healthcare Management
    • Health Services Research
    • Utilization Review

    Background:

    • Professional Standards Review Organizations (PSROs) are crucial for healthcare quality and cost control.
    • Traditional utilization review processes can be resource-intensive.
    • Optimizing review timing is essential for efficient healthcare operations.

    Purpose of the Study:

    • To evaluate the impact of exempting initial hospitalization days from utilization review.
    • To assess the financial and operational outcomes of a modified PSRO methodology.

    Main Methods:

    • Implementation of a new PSRO methodology exempting the first five days of hospitalization from review.
    • Analysis of utilization patterns and cost data before and after the methodology change.
    • Expansion of concurrent review processes.

    Main Results:

    • Significant cost savings were achieved following the methodology change.
    • Concurrent review processes were successfully expanded.
    • No adverse impact on patient care quality was observed (implied).

    Conclusions:

    • Exempting the initial phase of hospitalization from utilization review is a viable strategy for cost reduction.
    • This approach allows for more focused and potentially effective concurrent review.
    • Healthcare organizations can benefit from flexible utilization review protocols.

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