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Huntsville Hospital Executive Summary

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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. …show more content…

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

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