Beyond the Standard Podcast - Episode 5 - Utilization Review

Utilization Review - Tatum Parmer, RN, Standards Interpretation Specialist, ACHC Acute Care and Critical Access Hospital Accreditation & Sateesh Prakash, MD, board certified gastroenterologist, Physician Surveyor, ACHC Acute Care Hospital Accreditation

As a payor, CMS is interested in Utilization Review to evaluate the medical appropriateness of services (necessity of admission, length of stay, services provided) and has made it a Condition of Participation for hospitals serving Medicare and Medicaid beneficiaries. Beyond regulatory requirements, utilization review has application as a planning tool for a broad cross-section of healthcare facilities. Utilization review in the broadest sense uses data to evaluate allocation of resources in order to drive higher quality patient care and greater operational efficiency. Tatum Parmer and Sateesh Prakash share their nursing/administrative and physician perspectives on its value.

Need To Be Accredited?

0:00 Introduction
2:36 Matching clinical needs to care delivered
3:41 “A perfect tool for recognizing bottlenecks”
4:40 Bridging resources and physician time
6:20 Nurses as gatekeepers
9:58 The impact of COVID-19
11:50 “Front and center on the operational side”

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