Utilization Management

Utilization Management (UM)

Facilitates appropriate reimbursement for hospitalized patients. The UM team reviews each patient’s status daily and a hospitalist representing UM participates in Huddle at both VU and the VA. 

 

Patient Status: observation (OBS) vs inpatient (IP) 

  • OBS: short stays with frequent reassessments to determine IP versus discharge
      • May have ongoing treatments (i.e. IV antibiotics, nebs, etc.), not only monitoring
      • Same-day procedures admitted with complications
  • IP: longer stays (>2 midnights) w/ high risk of adverse outcomes, inpatient-only procedure, need for inpatient testing, or ICU admits
      • LOS should cross 2 midnights
      • Do not use for custodial care, patient/physician convenience, or “while they are here” expedited workups
      • Do not change status if Pt dies, leaves AMA, transfers hospitals, or opts for hospice