2.50
Hdl Handle:
http://hdl.handle.net/10755/161400
Type:
Presentation
Title:
Cost Analysis of a Cost Containment Strategy
Abstract:
Cost Analysis of a Cost Containment Strategy
Conference Sponsor:Midwest Nursing Research Society
Conference Year:2002
Author:Murray, Mary
P.I. Institution Name:University of Wisconsin
Title:Assistant Professor
Contact Address:School of Nursing, Clinical Sciences Center H6/150, 600 Highland Avenue, Madison, WI, 53792-2455, USA
Contact Telephone:608.263.6945
Purpose: To determine the costs associated with conducting concurrent utilization review (UR), a cost containment strategy used by the managed care industry. The UR process requires that providers communicate clinical information about hospitalized patients to payers who make a determination if the planned care is appropriate, medically necessary, and allowable under the terms of the contract with the provider. Care that is evaluated as meeting these criteria is certified for payment. Framework: A strategy of cost analysis is used within a production process model based in microeconomics. Sample: The 29 clinical services of a 500-bed academic health center were aggregated into 9 clinical groups. A random sample of 15 reviews per group was studied. Method: The cost to the hospital of conducting UR is a function of the time involved and the personnel conducting the review. A time sampling methodology was used to determine the time involved in conducting UR. Hourly salaries plus a proportionate share of fringe benefits were multiplied by the amount of time dedicated to the UR process to arrive at the personnel cost of the process. Results: Each review took an average of 15.41 minutes. Across services the average time of each review ranged from a minimum of 11.19 minutes (medical) to a maximum of (19.04) minutes (pediatrics). Non-clinically prepared support staff conducted approximately 44% of the reviews, 27% by advanced practice case managers, and 13% by master's prepared social workers. Over 12 months 13,106 reviews were completed at a personnel cost of $157,573.00. Conclusions: These figures are conservative in that they do not include the insurance company component of the costs which could be estimated to be equal to the hospital provider cost. Given a denial rate of less than 2%, it is reasonable to question the cost effectiveness of the process.
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.titleCost Analysis of a Cost Containment Strategyen_GB
dc.identifier.urihttp://hdl.handle.net/10755/161400-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Cost Analysis of a Cost Containment Strategy</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">2002</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Murray, Mary</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of Wisconsin</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Assistant Professor</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">School of Nursing, Clinical Sciences Center H6/150, 600 Highland Avenue, Madison, WI, 53792-2455, 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@facstaff.wisc.edu</td></tr><tr><td colspan="2" class="item-abstract">Purpose: To determine the costs associated with conducting concurrent utilization review (UR), a cost containment strategy used by the managed care industry. The UR process requires that providers communicate clinical information about hospitalized patients to payers who make a determination if the planned care is appropriate, medically necessary, and allowable under the terms of the contract with the provider. Care that is evaluated as meeting these criteria is certified for payment. Framework: A strategy of cost analysis is used within a production process model based in microeconomics. Sample: The 29 clinical services of a 500-bed academic health center were aggregated into 9 clinical groups. A random sample of 15 reviews per group was studied. Method: The cost to the hospital of conducting UR is a function of the time involved and the personnel conducting the review. A time sampling methodology was used to determine the time involved in conducting UR. Hourly salaries plus a proportionate share of fringe benefits were multiplied by the amount of time dedicated to the UR process to arrive at the personnel cost of the process. Results: Each review took an average of 15.41 minutes. Across services the average time of each review ranged from a minimum of 11.19 minutes (medical) to a maximum of (19.04) minutes (pediatrics). Non-clinically prepared support staff conducted approximately 44% of the reviews, 27% by advanced practice case managers, and 13% by master's prepared social workers. Over 12 months 13,106 reviews were completed at a personnel cost of $157,573.00. Conclusions: These figures are conservative in that they do not include the insurance company component of the costs which could be estimated to be equal to the hospital provider cost. Given a denial rate of less than 2%, it is reasonable to question the cost effectiveness of the process.</td></tr></table>en_GB
dc.date.available2011-10-26T23:20:45Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T23:20:45Z-
dc.description.sponsorshipMidwest Nursing Research Societyen_GB
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