Printer Friendly

SAVINGS IDENTIFIED IN PSYCHIATRIC REVIEW AS RESULT OF CONTRACT WITH MICHIGAN PEER REVIEW ORGANIZATION

 SAVINGS IDENTIFIED IN PSYCHIATRIC REVIEW AS RESULT OF CONTRACT
 WITH MICHIGAN PEER REVIEW ORGANIZATION
 LANSING, Mich., Jan. 9 /PRNewswire/ -- A potential savings of $7.6 million for one year has been identified by the Michigan Department of Social Services as a result of the contract with the Michigan Peer Review Organization (MPRO) to perform reviews of psychiatric hospital cases for the Medicaid program.
 These reviews are to assure that Medicaid pays for only psychiatric stays that are medically necessary at the hospital level. Data recently released for the period of October 1990 through September 1991 underscored the effectiveness of MPRO review as a part of the department's ongoing efforts to assure the appropriateness of Medicaid expenditures.
 MPRO's physician reviewers denied 19,760 days of care, or 6.3 percent of all psychiatric hospital days for Medicaid patients. At the average daily reimbursement rate of $320 per day, continued stay denials could save Michigan taxpayers over $6.3 million.
 MPRO's physician reviewers also considered 1.4 percent of proposed admissions medically unnecessary. At an estimated average cost of $5,500 per admission, these denials could result in a potential additional savings of nearly $1.3 million. Hospitals may ask the department to reconsider any MPRO denial.
 The department paid MPRO $1.3 million for fiscal year 1991 to operate this review program.
 Additional savings have resulted from a decrease in the average length of hospital stay due to closer monitoring of medical necessity and earlier discharge planning by hospital staff. Although this savings is difficult to measure, it represents a significant accomplishment by MPRO's review program in effecting change in the behavior of providers of psychiatric hospital services.
 Annualized length of stay and admission rate decreases suggest 40,000 fewer days than would be expected from past experience. This translates to an additional $13 million in costs that may have been avoided as a direct result of the review activity. Overall average length of stay declined by 11 percent between January 1990 and June 1991 from 18.1 days to 16.1 days. For adult patients, the length of stay decrease was a dramatic 16 percent.
 Decreases in the average length of stay tend to be permanent, and the department and MPRO anticipate that denial rates will decrease as hospitals continue to limit inpatient care more closely to those who require it.
 MPRO's Corporate Office and Psychiatric Review Program are in Plymouth, Mich. A regional office is in Lansing, with two supplemental offices in Marquette and Traverse City, Mich. As a statewide, independent, physician-sponsored organization, MPRO also conducts utilization review programs for Medicaid and Medicare recipients in general, acute care hospitals. MPRO reviews are performed by licensed, practicing physicians who evaluate medical records of Medicaid and Medicare patients.
 -0- 1/9/92
 /NOTE: Gary Horvat, chief executive officer of Michigan Peer Review Organization, is available for questions at 313-454-7224. CONTACT: Sherry L. Ross of Michigan Peer Review Organization, 313-459-0900, Ext. 619/ CO: Michigan Peer Review Organization; Michigan Department of Social
 Services ST: Michigan IN: HEA SU:


KK -- DE012 -- 8192 01/09/92 11:39 EST
COPYRIGHT 1992 PR Newswire Association LLC
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1992 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Publication:PR Newswire
Date:Jan 9, 1992
Words:514
Previous Article:/C O R R E C T I O N -- KETEMA EARNINGS/
Next Article:SUNBANK ECONOMIC FORECAST: 'PERSPECTIVE '92'
Topics:


Related Articles
PROs presage tighter squeeze on hospitals and labs.
Putting the lid on health benefits costs.
MICHIGAN PEER REVIEW ORGANIZATION CONFIRMS SUBSTANTIAL FINANCIAL IMPACT ON MEDICARE COSTS
MICHIGAN DEPARTMENT OF MENTAL HEALTH DIRECTOR JAMES HAVEMAN ANNOUNCES HOSPITALS ARE JCAHO-ACCREDITED
Michigan Peer Review Organization to Work With Macomb County Community Mental Health Services in its Access Center Operation.
Michigan Peer Review Organization to Work With Macomb County Community Mental Health Services in its Access Center Operation.
Michigan Peer Review Organization Wins Contract to Perform External Quality Review of Michigan Medicaid Services Provided by Qualified Health Plans.
Sheryl L. Stogis Resigns as Michigan Peer Review Organization's Chief Executive Officer.
Dr. orders nurses to follow his protocols--not hospital's.

Terms of use | Copyright © 2016 Farlex, Inc. | Feedback | For webmasters