Reducing Unnecessary Medicare Admissions

Abstract

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. Acute care hospitals. 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. 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.