The ability of your utilization review team to get a reasonable length of stay approved for your patients is absolutely crucial to both your patients’ chance of achieving long-term recovery and the financial sustainability of your organization. Yet we often ask our utilization review teams to work their magic with one or both hands tied behind their back.
In many organizations, UR is often asked to get at least 7 days of residential treatment approved for a seriously ill patient based upon vague information such as this:
In order to have a fighting chance of having the payor authorize seven initial residential days, however, they’ll need to be able to provide definitive answers to these specific questions:
- How severe is the patient’s addiction?
- What co-occurring disorders does patient have?
- Why is this level of care medically necessary?
- What is patient’s primary drug of choice?
- How much and how frequently was patient using?
- Is there suicidal ideation or self-harming behaviors?
- When was the last day patient used?
How do you provide your utilization review team with this detailed information when the patient may not even have met their clinician yet?
We can help. Vista’s intake questionnaire collects all of this information directly from the patient via an interactive online survey and summarizes it instantly in a two-page report on the patient’s dashboard. In addition to detailed sections on treatment goals, previous treatment episodes, demographics, underlying health conditions, and recent criminal justice events, the drug/alcohol use section summarizes the patient’s primary drug of choice, how they were using, the severity of the patient’s addiction, the last day they used, how long they’ve been using their preferred drug problematically, other drugs they’ve also used recently, and whether they’re taking opioid maintenance or anti-craving medication:
Combined with the co-occurring disorder assessments which are also included in Vista’s Patient Summary Report, your UR team with all the detailed information they need to negotiate persuasively for an appropriate initial treatment stay for your patients.
What If You Could Get 5%-10% More Days Approved?
Not only would more days in treatment increase your patients’ chances of recovery, but the additional revenue from these days would fall almost directly through to your bottom line. And because Vista’s research is surprisingly affordable, you could find that outcomes research increases your revenue by 2-3 times your research cost!
Think this is unlikely? One of Vista's clients who did a before- and after comparison found that they got 13% more days approved after they switched to Vista!