Administrative Memos

199904

FROM: Theodore O. Will, Chief Executive Officer
DATE: Apr 30, 1999
SUBJECT: Medicaid Quality Improvement Study On Recurrent Admissions
IPRO CONTACTS:

Andrea Goldstein, Vice President, Utilization Management, ext. 364

As Described In Medicaid Administrative Memorandum #98-10, Ipro Is Conducting A Study In Collaboration With The New York State Department Of Health On Recurrent Admissions In The Medicaid Population. Although The Study Is Based On Patients That Were Admitted Ten (10) Or More Times Per Year In 1997, You May Be Familiar With Recipients That Fit This Criteria For 1998.

Hospitals Will Fall Into One (1) Of The Three (3) Categories Noted Below:

Category #1:

If your hospital did not have any Medicaid recipients with recurrent admissions you will only receive this Administrative Memorandum (no attachments). No further action is required.

Category #2:

If your hospital treated any Medicaid patient(s) with recurrent admissions in 1997, you will receive Attachment I which is a case listing of the number of admissions at your hospital and the number of admissions to other facilities. Although we are interested in any comments you may have, no further action is required unless patient(s) were admitted five (5) or more times to your hospital (see Category #3).

Category #3:

If any of the patient(s) listed in Attachment I were treated at your facility five (5) or more times, you will receive Attachment I and Attachment II which lists patient-specific information including: the patient?s name, discharge diagnosis and dates of service for each of the five (5) or more admissions. Please review this data and provide IPRO with your written comments and/or suggestions for any interventions that are planned or have been taken for the non HIV-AIDS patients.

All correspondence should be sent to the attention of Andrea Goldstein, Vice President, Utilization Management within forty-five (45) days of the date of this memorandum. In addition to soliciting hospital feedback and comments, IPRO will also be selecting a sample of cases for review. As you will recall, the purpose of these activities is to identify possible alternatives for managing the health care needs of a small, but costly, number of Medicaid recipients. The results of IPRO's review and the comments/suggestions received from the hospitals will be compiled into a report to be shared with the Department of Health and the hospital community.

Please be aware, if your hospital is selected for medical record review, you will be notified under separate cover.

Should you have any questions in regard to this study, please feel free to contact me or Andrea Goldstein at extension 364.