Efficiency gains in utilization review.

A study was conducted to determine which Major Diagnostic Categories (MDCs) accounted for most of the nonessential hospital admissions in 73 Michigan hospitals in 1986. The Intensity, Severity, Discharge-Appropriateness (ISD-A) criteria set was used to identify nonessential admissions. Large concentrations of nonessential admissions were found in medical, psychiatric, and substance abuse cases; surgical admissions had low rates of nonessential hospitalization. Focusing utilization review on MDCs with nonessential rates exceeding 15% results in an examination of 44% of admissions, while capturing 77% of nonessential admissions and 73% of potential dollar savings. Implications for UR activities are discussed.