Medicaid Inpatient Psychiatric and Detoxification Utilization and 1 more...less...

Clinical Services Team: Quality Improvement & Clinical Integrity Unit

% of DVHA inpatient mental health and detox admissions with a reconsideration review request

0.0%SFY 2021

Line Bar
Notes on Methodology

Please note in the chart above that:   

  •  the solid trend line represents the % of total admits for which a secondary review was requested and
  • the dotted target trend line represents the % of total admits for which a doc to doc review was requested and
  • the SFY20 data point represent discharged admissions for Q1 as of 10/07/19 

Partners
  • Brattleboro Retreat
  • University of Vermont Medical Center
  • Central Vermont Medical Center
  • Rutland Regional Medical Center
  • Valley Vista
  • Serenity House
  • Department of Mental Health
  • Vermont Department of Health, ADAP
  • Department for Children and Families
  • Department of Corrections
Story Behind the Curve

There has been a significant decrease in the number of requests for reconsideration. This shows that there is agreement with the authorization decisions. Significant outreach and collaboration with providers likely contributed to the decline in reconsideration requests. Team members conducted site visits and educated clinicians about documentation requirements. Review of data shows that there was not an increase in average number of days authorized or length of stay.

 Last updated:  10/15/2020

Strategy

UR Team members have conducted:

  • site visits and educated clinicians about documentation requirements
  • a significant amount of outreach with sister departments to ensure that members are referred to the appropriate agencies for discharge services
  • weekly phone consultations with DCF to address discharge issues

The QICIU Director has developed a protocol with one of the major providers to analyze discrepancies prior to submitting reconsideration requests.

Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy