2.50
Hdl Handle:
http://hdl.handle.net/10755/161128
Type:
Presentation
Title:
Substitution of Hospital Staff in Concurrent Utilization Review
Abstract:
Substitution of Hospital Staff in Concurrent Utilization Review
Conference Sponsor:Midwest Nursing Research Society
Conference Year:2006
Author:Murray, Mary Ellen, PhD, RN
P.I. Institution Name:University of Wisconsin - Madison
Title:Associate Professor
Contact Address:School of Nursing, 600 Highland Avenue, Madison, WI, 53792, USA
Contact Telephone:608-263-6945
Co-Authors:Predoctoral Students: Julie V. Darmody, MSN, BSN, RN; Roberta Pawlak, RN, MS; Mary Hook, MS, RN; Yulia Semeniuk, MS, RN; Judith Westphal, MSN, RN; and Jeffrey Henriques, PhD, Assistant Research Scientist
Background: Concurrent utilization review (UR) is a payer strategy to control the cost of hospital care. From the provider perspective, the hospital must assign the concurrent UR function to staff who become responsible for communicating clinical information so payers agree to certify reimbursement. Purpose: The purpose of this research is to determine the effect that substitution of different categories of hospital employees has in the UR production process. Conceptual Framework: Microeconomic theory describes a production process as a relationship between a given quantity of output and the inputs used to produce it. One application of the production process is a determination of the least cost combination of inputs that will produce the same output. Hospital personnel are considered inputs into the production process for UR. Within the production process it may be possible to substitute less costly inputs for higher cost, scarce inputs such as registered nurses. Subjects: The sample included four categories of hospital staff that performed the UR function as part of their role at a 500-bed academic medical center. The categories included: Case Manager, Case Manager Associate, Registered Nurse, and Social Worker. Method: The study compared the number of reviews (26,636), number of denials (n=160), and number of denied days (n=536) for different categories of hospital staff performing concurrent UR over a two-year time period. Results: Results of this study show that there were no significant differences in number of denials or number of denied days when different categories of hospital staff conducted concurrent UR. Conclusions: The educational preparation of staff conducting UR was not found to have an impact on outcomes. Therefore, it would seem reasonable that hospitals could substitute other staff in place of registered nurses to complete the UR function, potentially increasing the availability of professional nurses.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Midwest Nursing Research Society

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleSubstitution of Hospital Staff in Concurrent Utilization Reviewen_GB
dc.identifier.urihttp://hdl.handle.net/10755/161128-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Substitution of Hospital Staff in Concurrent Utilization Review</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Midwest Nursing Research Society</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2006</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Murray, Mary Ellen, PhD, RN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of Wisconsin - Madison</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Associate Professor</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">School of Nursing, 600 Highland Avenue, Madison, WI, 53792, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">608-263-6945</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">memurra1@wisc.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Predoctoral Students: Julie V. Darmody, MSN, BSN, RN; Roberta Pawlak, RN, MS; Mary Hook, MS, RN; Yulia Semeniuk, MS, RN; Judith Westphal, MSN, RN; and Jeffrey Henriques, PhD, Assistant Research Scientist</td></tr><tr><td colspan="2" class="item-abstract">Background: Concurrent utilization review (UR) is a payer strategy to control the cost of hospital care. From the provider perspective, the hospital must assign the concurrent UR function to staff who become responsible for communicating clinical information so payers agree to certify reimbursement. Purpose: The purpose of this research is to determine the effect that substitution of different categories of hospital employees has in the UR production process. Conceptual Framework: Microeconomic theory describes a production process as a relationship between a given quantity of output and the inputs used to produce it. One application of the production process is a determination of the least cost combination of inputs that will produce the same output. Hospital personnel are considered inputs into the production process for UR. Within the production process it may be possible to substitute less costly inputs for higher cost, scarce inputs such as registered nurses. Subjects: The sample included four categories of hospital staff that performed the UR function as part of their role at a 500-bed academic medical center. The categories included: Case Manager, Case Manager Associate, Registered Nurse, and Social Worker. Method: The study compared the number of reviews (26,636), number of denials (n=160), and number of denied days (n=536) for different categories of hospital staff performing concurrent UR over a two-year time period. Results: Results of this study show that there were no significant differences in number of denials or number of denied days when different categories of hospital staff conducted concurrent UR. Conclusions: The educational preparation of staff conducting UR was not found to have an impact on outcomes. Therefore, it would seem reasonable that hospitals could substitute other staff in place of registered nurses to complete the UR function, potentially increasing the availability of professional nurses.</td></tr></table>en_GB
dc.date.available2011-10-26T23:16:20Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T23:16:20Z-
dc.description.sponsorshipMidwest Nursing Research Societyen_GB
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