Avoidable Day Analyzer
Data Identification Tools for Effective Case Management, Second Edition
Gayle Riley, RN, PHN, MPA-HAS
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Avoidable days cost more than dollars on the bottom line—They put patients at risk for hospital-acquired conditions, create bed grid-lock, and increase scrutiny from regulatory agencies and recovery audit contractors.
Discover why avoidable hospitalization days occur, who's responsible for them, and how to tackle the problem head on with HCPro's Avoidable Day Analyzer: Data Management Tools for Effective Case Management, Second Edition. This new edition of a best seller and the accompanying tools have been updated to become powerful weapons against current case management concerns. Author Gayle Riley's hands-on expertise will help case managers analyze and improve performance in the form of avoidable days.
This updated second edition features:
- Clear instructions about how to use the tools in the Avoidable Day Analyzer
- Easy to follow step-by-step processes
- Ability to plug in your hospital’s unique data and instantly get the detailed analysis you need to make process decisions
Take a look at what’s covered:Section 1: The Avoidable Day Analyzer
- Moving from an ordinary case management system to an extraordinary one
- Avoidable days and hospital-acquired conditions
- Avoidable days and recovery audit contractors
Section 2: The potentially avoidable day (PAD) indicator report
- Using your PAD indicator report
- What the PAD indicator report can tell you
Section 3: Conducting your validation audit
- The process
- Audit basics
- Case study: Interpreting one hospital’s validation audit results
Section 4: Avoidable-Day Tracking
- Understanding how to document using medical necessity criteria
- Educating staff
- Steps for effective utilization review
Section 5: Ensuring Success
- Strategies for avoidable day data collection
- Kickoff: Using your Avoidable Day Analyzer database
- Information for Access 2007 users
Case Management Credits (CCMC):
This activity has been approved by the Commission for Case Manager Certification for 4 Continuing Education Units.
Nursing Contact Hours (ANCC):
HCPro, Inc. is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center Commission on Accreditation. This educational activity for 3 nursing contact hours is provided by HCPro, Inc.
About the author:
Gayle Riley, RN, PHN, MPA-HAS is a former independent consultant who knows how to make turn avoidable days into a compliant bottom-line success. She created the medical management and case management program for San Francisco-based Catholic Healthcare West that found $18.4 million in annual cost savings and another $21.6 million in new revenue from increased admissions and efficiency practices. She went a step further and developed an electronic avoidable day program plus and electronic physician practice analysis severity-adjusted system that allows physicians to measure their efficiency in managing length-of-stay and costs against state averages.
Tools and forms included in this second edition:
- Base DRG Spreadsheet: A preformatted report containing all of the DRGs needed to compute the PAD Indicator, including the geometric mean length of stay (GMLOS) and 90th Percentile LOS as provided by the Centers for Medicare & Medicaid Services for its fiscal year 2009.
- Sample audit sheet: A tool you can customize and use to audit medical records and help validate your PAD Indicator, following the step-by-step audit instructions in the book.
- PAD Access Database: An original Access database created by HCPro staff under the author guidance.
- Sample PAD Access Database: Includes fictitious data in a PAD database to demonstrate how data might appear.
- PAD Indicator Report: A preformatted report that computes a hospital’s PAD Indicator, the monetary value of the days you will save and the additional bed-days your hospital will gain.
- Sample utilization management policy: Provides procedures for consistent, reliable utilization review (UR) case referral for medical staff review and action as part of an effective case management program.
- Sample of UR data collection tools: Small charts to imbed in your current review sheets to standardize collection of potential avoidable days (PADs) and be the source used for data entry into your PAD Access database.
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