Precertification Approach For Patients

The need for, and the value of, precertification is evidenced by the wide variation is costs associated with the delivery of such services. The most dramatic of these differences occur with respect to geographicoriented variations; however, significant differences also occur within local areas and regions from providertoprovider.

Total cost of care differences are a function of a variety of factors. These factors include, the cost of the procedures involved, the lengths of stay, the number and types of tests required, and so forth. In each instance, variations can occur on the bases of regional and local practices, differences in provider orientations, and other determinants.

When the hospital utilization review is used in conjunction with precertification, specific diseases and conditions are targeted for inpatient or outpatient treatment, and a fee

1 2for service schedule is established. The hospital review procedure is an essential element in the establishment of a precertification program.

The specific list of diseases and conditions for a focused precertificatio

. . .
care expenditures for an organization could actually increase. 4 GEOGRAPHIC VARIATION DATA The need for, and the value of, precertification for the delivery of health care services is evidenced by the wide variation is costs associated with the delivery of such services. The most dramatic of these differences occur with respect to geographicoriented variations; however, significant differences also occur within local areas and regions from providertoprovider. Total cost of care differences are a function of a variety of factors. These factors include, the cost of the procedures involved, the lengths of stay, the number and types of tests required, and so forth. In each instance, variations can occur on the bases of regional and local practices, differences in provider orientations, and other determinants. Some examples of differences which result in significant variations in total costs for care are as follows: 1. Use of assistant surgeons in hipreplacement procedures: 69 percent in Seattle; 45 percent in Birmingham; 35 percent in Milwaukee; and 27 percent in Hartford (Mitchell, 1987). 2. Fees for surgery alone in coronary artery bypass grafts: $4,012 in Seattle; $3,517 in Hartford; $3,277 in Milwaukee;
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Some common words found in the essay are:
, Economic Advisers, VARIATION DATA, Tillotson Rosada, Howell Buczko, Schori Jaffe, Buck Mastanduno, PRECERTIFICATION Precertification, Business Health, FOCUSED PRECERTIFICATION, health care, electric employees, electric employees assigned, utilization review, employees assigned, inpatient outpatient, care costs, business health, hospital utilization review, hospital utilization, health care costs, council economic advisers, health care services, mastanduno 1990, council economic,
Approximate Word count = 1706
Approximate Pages = 7 (250 words per page)

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