If a hospital has a higher-than-expected level of PPCs, why would a health insurance plan think that the hospital can find ways to reduce the level of PPCs

If a hospital has a higher-than-expected level of PPCs, why would a health insurance plan think that the hospital can find ways to reduce the level of PPCs, and thus reduce unnecessary utilization of services, and reduce the length of stay?

Expert Solution

Utilization management is known to be the medical necessity evaluation,efficient and appropriate use of health care services with different procedures and facilities under the provision of the applicable health benefits plan.It has three types.

Concurrent review that perform during course of care and treatment
Prospective review that performed rendered care to eliminate/reduce unnecessary services
Retrospective review conducted after completion of services.

Potentially Preventable Complications (PPCs) is a method that uses present on admission (POA) indicator for the identification of complications on secondary diagnoses that arises after admission.Hospital has a higher-than-expected level of PPCs,and health insurance plan think that the hospital can find ways to reduce the level of PPCs,because with respect to a person it is a harmful event that gives negative outcomes.It creates infections or even complications during surgeries.It occurs after persons admission to a hospital or if there is long term care facility.It also results for a lack of care or the treatments in the hospitals during course.Texas do care about PPCs due to its cost,value and quality.

In this methodology such as A/E(actual and expected rates or ratio) ratios,POA(present on admission),Software and data are used.PPC programs are used in quality based program,DSRIP and DSHS.They are under hospitals control and thus reduces unnecessary utilization of services, and reduce the length of stay.

keosha answered 2 years ago

The patient's health insurance plan has a $750 deductible for hospital visits, and then it covers...

The patient's health insurance plan has a $750 deductible for hospital visits, and then it covers 100 percent of hospital charges. The patient's first hospital visit this year had charges of $612. The patient was subsequently admitted to the hospital a second time this year, and the charges totaled $358. How much will the patient be billed for each visit? Visit 1 Visit 2 How much will the health insurance plan reimburse for each visit? Visit 1 Visit 2

The smith family has a basic health insurance plan that pays 80% of out of hospital...

The smith family has a basic health insurance plan that pays 80% of out of hospital expenses after a deductible of $250 per person. If 3 family members have doctor and prescription drug expenses of $877, $1,659, and $192 respectively, how much will the smith family and the insurance company each pay? How could they benefit from a flexible spending account established through mr.smith's employer? What are the advantages and disadvantages of establishing such an account?

The Baulding family has a basic health insurance plan that pays 80 % of out-of-hospital expenses...

The Baulding family has a basic health insurance plan that pays 80 % of out-of-hospital expenses after a deductible of $250 per person. If three family members have doctor and prescription drug expenses of $ 993, $1,419, and $201 respectively, how much will the Baulding family and the insurance company each pay? How could they benefit from a flexible spending account established through Mr. Baulding's employer? What are the advantages and disadvantages of establishing such an account?

How would you suggest the United States reduce the cost of medical health insurance? Why do...

How would you suggest the United States reduce the cost of medical health insurance? Why do you think the United States has not adopted the approach to health care as Canada, France, and much of the developed world?

three ways a health care provider can reduce days in AR.

Your hospital is negotiating with medical insurance providers, who would like to reduce the amount they...

Your hospital is negotiating with medical insurance providers, who would like to reduce the amount they pay as reimbursement for hospital stays. For a particular procedure, they would like to reduce payment by $300 and have patients go home one day earlier. To see what effect this would have on hospital costs, a random sample of 50 patients who were recently admitted for this procedure was analyzed. Had they left one day earlier, the average savings would have been $322.44,...

Why do you think health insurance in America is as complicated as it is?

Talk about three ways (other than money!) that you would motivate employees. Why do you think...

Talk about three ways (other than money!) that you would motivate employees. Why do you think these methods would work? must be 250 words!

Why would a bond with a yield higher than the coupon rate sellat a discount?...

Why would a bond with a yield higher than the coupon rate sell at a discount? Why would a bond with a yield lower than the coupon rate sell at a premium?

1. ABC Company has produced a higher level of production in May than it produced in...

1. ABC Company has produced a higher level of production in May than it produced in April, but had the same variable costs per unit and the same total fixed costs. Which of the following is true about May’s reported costs? A. Total variable cost is less in May B. Total cost per unit is less in May C. Total cost per unit is more in May D. Total fixed costs are more in May 2. Depreciation on sewing machines...

Question