Smith Andrew L, Kulhari Ashish, Wolfram Julie A, Furlan Anthony
Department of Neurology, University Hospitals Case Medical Center, Cleveland, Ohio.
Department of General Medics, Center of Regenerative Medicine, Case Western Reserve University, Cleveland, Ohio.
J Stroke Cerebrovasc Dis. 2017 Apr;26(4):711-716. doi: 10.1016/j.jstrokecerebrovasdis.2015.12.037. Epub 2017 Feb 24.
The purpose of this study is to determine if the common insurance practice of requiring precertification before a medically ready stroke patient can be discharged to a skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF) causes a delay in discharge. Eliminating delays in discharge of stroke patients is important given the increasing demands for health-care efficiency after the passage of the Affordable Health Care Act.
A retrospective chart review of 1007 patients who were admitted to our comprehensive stroke center with the primary diagnosis of stroke over a 12-month period was performed. Out of the patient pool, 289 patients met the inclusion criterion of a primary diagnosis of stroke that required discharge to a SNF or IRF. All 289 patients were medically cleared for discharge to a SNF or IRF by a board-certified vascular neurologist.
Of the 289 patients who met the inclusion criteria, 118 required insurance precertification and 171 did not require precertification before being discharged to a SNF or IRF. All 118 patients who required precertification had private health insurance. The patients who required insurance precertification had an average delay of discharge (DOD) of 1.5 days, and those patients who did not require precertification had an average DOD of .8 days (P value <.0001). After removing the outliers, the difference in the length of stay (LOS) between the 2 groups became statistically significant (P value < .04).
The results of this study demonstrate that insurance precertification leads to delay in discharge, increased LOS, and increased hospital costs for stroke patients.
本研究旨在确定在医学上已准备好的中风患者被转至专业护理机构（SNF）或住院康复机构（IRF）之前，保险公司要求预先认证的常见做法是否会导致出院延迟。鉴于《平价医疗法案》通过后对医疗保健效率的需求不断增加，消除中风患者出院延迟至关重要。
对在12个月期间入住我们综合中风中心、主要诊断为中风的1007例患者进行回顾性病历审查。在这些患者中，289例符合主要诊断为中风且需要转至SNF或IRF的纳入标准。所有289例患者均经一名获得董事会认证的血管神经科医生批准可转至SNF或IRF。
在符合纳入标准的289例患者中，118例在转至SNF或IRF之前需要保险预先认证，171例不需要预先认证。所有118例需要预先认证的患者均拥有私人医疗保险。需要保险预先认证的患者出院平均延迟（DOD）为1.5天，而不需要预先认证的患者平均DOD为0.8天（P值<0.0001）。去除异常值后，两组之间的住院时间（LOS）差异具有统计学意义（P值<0.04）。
本研究结果表明，保险预先认证会导致中风患者出院延迟、住院时间增加以及医院成本增加。
