HSA 4191 Chapter Notes - Chapter 10: Utilization Management, Medical Necessity, Managed Care
Document Summary
Under fixed-price and capitation payment systems, cost containment and efficient resource utilization are pivotal to success. External mandate for utilization review by regulatory agencies and insurance companies are more than balanced by internal drivers for ensuring that resource utilization is optimized. Managers must ensure that services are available when needed and that personnel and technology re efficiently allocated and scheduled. These efficiency needs are met through computerized monitoring and scheduling systems. Inpatient occupancy rates: clinic and emergency department activity, utilization of individual service facilities. Such as the operating suite or diagnostic units. Patient scheduling systems are used for advance booking and scheduling of facilities: both for patient and physician convenience and for efficient allocation of resources, particularly staffing. Comprehensive and timely data are essential to monitor use of expensive diagnostic and treatment technologies to achieve optimal revenue returns on capital investments. Computer programs can project the average length of stay for each elective admission once historical data have been accumulated.
