Did you know?
- Inpatient services are the highest cost services and therefore reflect the highest level of payment from the Medicare Trust Fund.
- Utilization data will always play a critical role in structuring the healthcare delivery system to ensure that patients receive the right care in the right place at the right time and for the right cost.
- As a general rule, patients should meet certain standards for intensity of services and severity of illness to be admitted. National and Local Coverage Determination (NCD, LCD) policies should be complied with to ensure medical necessity.
Why should I care?
- Utilization changes are early detectors of your hospital’s market share risk.
- In actionable terms, utilization data can help reveal your hospital’s strengths and its vulnerabilities, including:
- How effectively are you reducing unnecessary readmissions?
- How much disparity exists within your affiliated physician groups?
- To what extent are you transferring care to outpatient settings?
What should I do?
- Review the most current utilization data internally, for your hospital, and externally, for your immediate service area, to understand the utilization shifts in “real time.”
- Compare your services internally and against your competition to learn which variations exist and why.
- Identify which services are being treated in an alternative setting to determine if you are successfully transferring care within your own system, or losing to a competitor.