Simplify and standardize Concurrent Inpatient Reviews

Efficiently adjudicate Per Diem payment arrangements

Reduce review times by up to 80%, with almost 100% inter-rater reliability

Objectively document the appropriateness of adult inpatient hospital admissions

Quickly and easily document Quality Improvement compliance

Maximize Hospital reimbursement under new Pay-For-Performance, DRG and Case Rate criteria

Better control hospital operating expenses and reduce staffing

Hospitals are being financially squeezed from all sides – Efficiency and Effectiveness have become critical for survival

Providing patient care occurs in “real-time”

BUT…Appropriateness of care is often measured “retrospectively” or after-the-fact

Simplifies and standardizes Concurrent Inpatient Reviews

Efficiently adjudicates Per Diem payment arrangements

Reduces review times by up to 80%, with almost 100% inter-rater reliability

Makes objective recommendations about the appropriateness of an admission, continued hospital stay, or a discharge

Quickly and easily documents Quality Improvement compliance

Maximizes hospital reimbursement under new Pay-For-Performance, DRG and Case Rate Criteria

Provides effective tool to better control hospital operating expenses and reduce staffing

Monitors the “real-time” status of hospital inpatients

Assists physicians in providing appropriate quality of care to patients, and documents compliance without need to pull and review medical charts / records

Cardiology Family Practice General Surgery Hospitalists Infectious

Disease Intensivists Internal Medicine Nephrology

Obstetrics/gynecology Ophthalmology Orthopaedic Surgery Pediatrics Psychiatry Psychology Pulmonology Urology

MSR Inpatient MAP – for Inpatient Concurrent Review

MSR Quality MAP – to prompt collection data and document compliance, for quality improvement studies

MSR Resource MAP – used for the daily monitoring of staff and hospital resources

Physicians provide patient care in real-time

However, other hospital functions (including administrative, regulatory, and compliance) are retrospective decision-making processes

Software that purports to assist physicians must operate in real-time

Ever-increasing costs in the 1970’s and 1980’s stimulated growth of organizations for managing costs (“financing”) and regulating patient safety

All currently available concurrent review tools were developed to meet the needs of these organizations – not the needs of real-time decision-makers in a hospital setting!

They developed tools to gather data and to meet their financial review and payment needs

The use of their ‘patient diagnosis algorithms’ became the norm for “managing” care

However, those algorithms do not readily translate to real-time hospital and clinical decision-making

These agencies (which now include quality-of-care monitoring) also function as retrospective review decision-makers

They adopted the diagnosis-based applications developed by the Financial Industry as their tools for monitoring safety and quality of patient care

The existing tools cause needless tension between the reviewer and the attending physicians by relying on diagnostic codes – codes which are frequently not accurate and cannot be determined at the time of hospitalization

BUT…

There are no “real-time” tools available to Health Plans to monitor and insure that diagnostic and/or treatment interventions recommended by national practice guidelines (and often sought by Payers and Hospitalist reviewers) are actually delivered.

Had to adopt them out of “self-defense” and to assure payment – and to understand how to appeal underpayments and denials based on those diagnosis-based algorhythms

These tools do not meet the hospital or medical staff needs associated with the practice of medicine.

Two significant studies have been conducted to evaluate the effectiveness and comparability of the MSR Inpatient MAP to existing concurrent review tools available to hospitals and health plans…

NevadaCare, Inc., (managed care insurance company with clients in Nevada, Iowa and Illinois) used both instruments for concurrent review of the same hospitalized patients in 2003 and 2004

NevadaCare, Inc. determined that 973 inpatient days met MSR Inpatient MAP continued stay criteria, 20 fewer than the 993 inpatient days that met InterQual/McKesson.

NevadaCare, Inc. concluded that the MSR Inpatient MAP was easier to administer and took less time to complete

A national Trust Employer Welfare Association (TEWA), in 2005, used the MSR Inpatient MAP to audit appealed denial-of-coverage determinations previously made using InterQual/McKesson

The audit of 123 admissions, 507 days, identified the same number of denied days.  However, case specific days differed slightly

the TEWA found that reviewer’s inter-rater reliability was close to 100% when using the MSR Inpatient MAP.

Concurrent Review today requires diagnostic codes – which are frequently not accurate nor can be readily determined at the time of admission – doctors make decisions based on organ system instability, not diagnoses

Quality of Care is difficult to improve and measure because there are no real-time tools to monitor and insure that recommended interventions (per national practice guidelines) are delivered to patients

Hospital Resources are difficult to audit and optimally allocate

COMPUTER SYSTEM REQUIREMENTS:

NEW SOFTWARE IS DESIGNED TO OPERATE ON MICROSOFT WINDOWS 7, VISTA, XP, OR 2000 (WITH SERVICE PACK 4)

PRINCIPAL DATA EXCHNAGE PROTOCOL:HL7; BOTH ROUTING AND LISTENING IS SUPPORTED.

ENCRYPTION TYPE: AES- 256

FILES COMPATIBLE WITH: CSV FILE IMPORT SPREAD SHEET FILE IMPORT ACCESS IMPORT EXCEL IMPORT DATA EXPORT FORMAT: MSSQL IMPORT / EXPORT SPREAD SHEET FILE IMPORT TEXT (CSV) – BATCH DATA

EXPORT/IMPORT VIA SQL