Rural Spotlight

Potentially Avoidable Admissions Cost Billions

Hospitals in 2006 spent $30.8 billion on 4.4 million hospital admissions that might have been avoidable, according to a report by the Agency for Healthcare Research and Quality.  The Nationwide Frequency and Costs of Potentially Preventable Hospitalizations 2006 report, based on data from the Healthcare Cost and Utilization Project, shows congestive heart failure and bacterial pneumonia were the two most common reasons for inpatient stays, accounting for total hospital costs of $15.6 billion.  Medicare patients accounted for $20.1 billion of the full amount spent on potentially preventable stays. Patients with private insurance were responsible for $4.7 billion of the $30.8 billion in 2006.  AHRQ analyzed hospital discharges, with each discharge counting separately for one patient admitted multiple times to a hospital to determine costs.  The federal agency applied its prevention quality indicators in the research to determine when a hospital stay might have been considered preventable with improved outpatient care.

RAC Reviews & Strategies

While Missouri critical access and rural hospitals aren’t currently scheduled for RAC Reviews, now is the time to prepare.  During a Rural Health Resource Center conference call on this topic, some helpful tips were relayed.  View the RAC federal website here.  Click here to view a list of common errors being found in RAC reviews. The following is a list of helpful guidelines to follow.

• Review the ABN process (ABNs may shield from a RAC Review)
• Internal and external audits need to be conducted prior to a RAC review (coding reviews, documentation to support medical necessity)
• Focus on pharmacy and therapy and the billing of “units” of service
• Review appropriateness of place of service, i.e. observation, inpatient short stays, 3 day hospital stay requirement for swing bed and SNF admission
• Think about establishing a reserve fund
• Someone needs to be dedicated to log, respond, follow-up and understand RAC reviews.  Deadline for responding is 45 calendar days.
• Watch remittance advise for code N432, which indicates an adjustment based on RAC review
• Monitor any previous reports from Medicare, track denials (by service, physician, etc.).  Fix errors once recognized
• Review Office of Inspector General and Government Accountability Office reports on their website.
• Review policies of UR, Case Management, and Discharge Planners
• Be sure hand-written notes are legible.

 

Missouri Clinical & Quality Conference

The 2009 Missouri Clinical & Quality Conference, hosted by the Missouri Primary Care Association and the Oral Health Network of Missouri will be held May 28-30.  It will be held at Big Cedar Lodge, near Branson, MO.  Open this flyer for more information.