Reducing unnecessary medicare admissions: a six-state project.

Purpose/objectives: 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.

Primary Practice Setting: Acute care hospitals.

Reducing unnecessary Medicare hospital admissions for chest pain in Arizona and Florida.

Purpose/objectives: Each year in the United States, more than 4.4 million patients with chest pain (DRG 143) present to emergency departments. Many of these admissions do not have documented justification to support an acute inpatient admission.

A case management protocol: reducing unnecessary Medicare admissions in Florida.

The Florida Medicare quality improvement organization implemented a case management project with 20 acute care hospitals to reduce unnecessary Medicare admissions. The project called for hospitals to implement a protocol to assign patients to observation or inpatient admission status. Results of the project showed a 67% reduction in the denial rate for the participating facilities.