Huntsville Hospital maintains the purpose of the utilization committee is to strive to provide efficient and appropriate health care services in the least costly manner. Collaborating professionals employ recognized standards while maintaining the quality of healthcare.
Utilization Review (UR) plans, essential for providing an outlet to examine important utilization concerns, ultimately improve operations and decrease health care costs (Anonymous 2013). Huntsville Hospital’s UR plan consist of determing the efficiency and appropriateness of treatments, identifying patterns of over and under utilization, employing improvement plans while educating hospital employees, medical staff, administration and the governing board of the hospital.
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The UR committee delegates daily review activities to the case managers as well as instances when more information is necessary from a patients physician, or ancillary departments. Review and evaluation of discoveries from routine UR activities and financials allows the Utilization department to offer suggestions while affected departments have the responsibility of reviewing the utilization reports. Ultimately, the Senior Leadership Team possesses the responsibility of the implementation of Huntsville Hospital’s Utilization Review …show more content…
In both plans a physician advisor reviews cases but within HH the case manager compiles all the clinical data and reviews, seeking the advice of physician advisor if necessary. Equally, the plans provide for utilization review to be initiated within the first twenty-four hours of the patient’s admission, if not prior to admission. In addition, both plans provide opportunities for the admitting physician to provide proof or argument for discrepancies in treatments or length of stays. Although the UK HealthCare UR plan provides a single physician review of inadequate treatment or length of stay, HH UR plan stipulates a minimum of two physician members review additional information submitted via the admitting physician. Specifically, in the HH UR plan exists a component of a continuous medical care evaluation studies to provide provisions for the Continuous Quality Improvement Committee. In addition, physicians continually need to be educated on detail specific care in HH, as physicians occasionally do not want the prescribed orders challenged. Pre-printed patient progress notes with check boxes assist some of HH’s physicians in considering necessary or unnecessary treatments
However, if the manager of this department sees improvement and would like too, she can recommend this process to other departments throughout the hospital. This could possibly lead to a positive impact on the hospitals overall score in patient
Case managers also provide support and information to patients and their families. Next, is utilization review. `Its main objective is to review each case and determine the most appropriate level of services, the most appropriate settings in which the services be delivered, the most cost efficient methods for care delivery and the need for planning of subsequent care. Other methods used for utilization and control are choice restriction and practice profiling' (Douglas, 2003, p.328).
Nightingale Hospital complying with Joint Commission’s is not occurring. The Universal Protocols (UP) met on some months and not on others. The Time-Out Hospital Wide UP looks like hospital was increase in compliance over the year and reached the one hundred percent make until December. This protocol should be preform at every surgery or minor procedure (where necessary) according to hospital policy in which involves laterality. The National Patient Safety Goal Data (NPSG) for communication in Hospital Wide Compliance of Reporting Critical Results within sixty minutes met one hundred percent, zero
UP.01.03.01 requires a time-out before the start of the procedure. The Site Identification and Verification policy describes the time-out process however the policy falls short of fully meeting the intent of this standard. EP 2 describes which team members must participate in the timeout, EP 3 requires a time-out before each procedure when two or more procedures are being performed, and EP 5 requires documentation of the time-out. These 3 elements are missing from the hospital policy/process and therefore revisions to the process/policy are necessary to include these 3 elements. Nightingale’s Safety Report reveals increasing compliance (nearing 100%) with the time-out process, however as mentioned above, EP 5 requires documentation of the process. In addition to the policy revision, I recommend the development of a unique form which will be used to document
| * 2a) Document review of hospital policy and procedures in practicum journal * * * * * * * * 2b) Submit a copy of the needs assessment program outline with changes in the practicum journal * * * * * 2c) Document review of program outline with mentor in practicum journal * * * * * * 2d) Submit program outline and power point presentation with speaker notes in
In order to, differentiate between utilization management and case management using the seven case management standards, it is first important to define each individual component. To begin with, a key component of quality and cost effective care is Utilization Management (UM). Utilization management is a way to assure that the appropriate care is medically efficient, a suitable use of health care services, proper procedures, and is applicable with provisions aligned in the health benefits plan. Case Management engages quality services in a timely coordination of patients’ specific needs in an approach that promotes positive outcomes by means that are cost effective. Case management may be developed during a single health care setting that may then transition throughout the care continuum. The seven standards are key components that described to maximize benefits and minimize the opposition.
The North Texas State Hospital (NTSH) is part of the Department of State Health Services (DSHS) administration. NTSH is a mental healthcare facility that has two campuses: one department is located in Wichita Falls, TX and the other in Vernon, TX. Including both campuses DSHS is the largest mental hospital in the state of Texas, which provides psychiatric services for the mentally ill. NTSH is the only facility in the entire state of Texas that provides forensic psychiatric care. Forensic psychiatric care is a specialized service for prisoners who have mental disorders. NTSH offers a 284-bed maximum security program for adults and a 78-bed adolescent Forensic Program (DSHS Center, 2017). NTSH aims to improve the health, safety, and wellbeing of individuals by providing the right stewardship, reducing health care problems, improving public health awareness, and preventing diseases. In order to improve health and safety, NTSH is accredited by the Joint Commission on Accreditation of Healthcare Organizations. The Joint Commission is an independent, not for profit association that set standards to evaluate
In 1974, the federal government adopted the Uniform Hospital Discharge Data Set (UHDDS) as the standard to help improve the uniformity and comparability of hospital discharge data, the principal diagnosis, and other diagnoses for hospital procedures; including comparable data that could help to determine which hospitals were best at treating patients and for reporting inpatient data in acute care, short-term care, and long-term care hospitals. This dataset works towards a standardized system of reimbursement for the federal government nationwide which in turn could lower costs, UHDDS helps in collecting general information pertaining the patient and the specific care including the age, sex, and race of the patient. The data elements are collected
5. Compliance of hospital policy regarding H&P completion within 24 hours of admittance will be reassessed in 90 days with a random sample of 20 patient charts. If compliance is rated at <98% the action plan will be reassessed and additional solution and sanctions will need to be implemented.
The RUC will be able to provide treatment to patients suffering from non-life threatening conditions and the most common illness, including pneumonia and flu, fevers, upper respiratory infections, sprains and strains, lacerations, contusion, and also necessary screening test, such as High Blood Pressure, mammogram, diabetes. Since the late 1980s and early 1990s, hospitals have looked to facilities such as RUCs as a means to reduce rate of inappropriate ED utilizations by triaging patients to less acute settings. The ED is not the most appropriate care setting for many patients, such as elderly patients and young children. Non-urgent patients account for well over 10 percent of the average ED’s caseload, and semi-urgent cases account for another
Internal Processes * Qualify for a Patient Centered Medical Home (PCMH) * Communications – (entire staff) – with a quarterly staff meeting * Improve comfort levels with ICD-10 diagnosis coding
Tulsa Memorial Hospital (TMH) is one of the nine acute care hospitals that serves in the general population area. Historically, it has been highly profitable due to its well-appointed facilities, excellent medical staff, good-standing reputation for quality care and its ability to give individual attention for each of its patients. The hospital, in addition to its inpatient services, operates an emergency department and an urgent care center located two miles from the hospital across the street from a major shopping mall.
Heritage Oaks Hospital provides a less restrictive step-down treatment environment at three outpatient centers: Harbor Oaks in West Sacramento serves adults and senior adults; Roseville Oaks serves adolescents, adults, and senior adults; and Winding Oaks next to the main hospital serves adults and senior adults. According to course textbook, the goal of outpatient programs is to improve quality of life and to return clients to daily activities among family, peers, and the community (Varcarolis, 2013). The treatments available include psychiatric, emotional, behavioral, and substance abuse. These outpatient centers have partial hospitalization program (PHP) and intensive outpatient program (IOP). According to the hospital website, outpatient services include physician oversight, medication management, group therapies, educational practices such as cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) (heritageoakshospital.com, 2017). I was assigned to Roseville Oaks Outpatient Behavioral Health Center. It was helpful for me to
South Beach Hospital operates with commitment and honesty, which is what attracts our patients. While excellence and trust are at we strive for, every employee here also equally value teamwork. Our continuous commitment to advancement and innovation is what allures our patients from as far away as Palm Beach to the north and Key West to the South.
Under this approach, as an example, United averages on any given day about 27,000 members in an inpatient setting and another 14,000 members receiving services in a skilled nursing facility. These members are managed by 2,000 clinical employees working with attending physicians to achieve optimal quality outcomes and having proper discharge plans in place when members leave the facilities in order to prevent unnecessary readmissions. United also expects to make one million house calls and home visits for its Medicare members aimed at enhancing adherence in care plans and closing care gaps.