Utilization Management of Orthopedic Services by Fitzsimons Army Medical Centerand Evans Army Community Hospital

摘要

This study involves designing an integrated UM Program for orthopedic servicesfor Fitzsimons Army Medical Center (FAMC) and Evans Army Community Hospital, Fort Carson, Colorado. Since Evans Army Community Hospital is the designated DoD lead agent or the Colorado Springs Health Services Area, the coordination of orthopedic services between Evans Army Community Hospital and the U.S. Air Force Academy Hospital is incorporated in this study. The use of prospective, concurrent, and retrospective reviews, cases management, discharge planning, and other UM tools which have been widely utilized in the civilian sector are reviewed. Staffing, workload, NonAvailability Statements (NAS'S), supplemental care costs, partnership agreements, referral system, and UM practices as they pertain to orthopedic services are analyzed. This study provides FAMC with a strong foundation for designing a regional UM Program that can be applied to the other high CHAMPUS costs within FAMC's geographical areas of responsibilities. FAMC's graduate medical education (GME) mission and the importance of maintaining its vital patient referral base are also considered in this study. Utilization management program.