Effective Utilization Management in a Military Treatment Facility

摘要

Healthcare systems and facilities across the country have used utilization management as a response to the pressures of declining revenue, increasingly competitive markets, and escalating operating expenses. The result of utilization management is a reduction of inpatient operations, as well as excess capacity. Wilford Hall Medical Center was studied, using primarily the Medical Expense Performance Reporting System (MEPRS) and Corporate Executive Information System (CEIS) data systems, to determine the magnitude of inpatient activity reduction. In addition, other factors such as Department of Defense referral policy changes and changes in the beneficiary population were examined to determine their role in the decline of inpatient activity.