Service Overview

Columbia Healthcare Analytics, Inc. provides Interactive External Utilization Review (IEUR) through three phases of service.

Phase I: Exploratory Utilization Review

A number of hospital charts are selected at random. Typically IEUR of 100 charts is recommended, but as few as 20 charts or as many as one month’s sample may be selected. The fee for Phase I is $190 per chart. This includes a critique of each chart, the results of which can be reviewed by the hospital, the transfusion committee, each department chair and each involved ordering physician. The analysis will give the client an opportunity to assess the appropriateness of their current blood or other service utilization and to learn how IEUR works. Potential systemic hospital utilization problems are identified, as well as constructive feedback provided on individual cases to improve physician practice. It is anticipated that this feedback alone may reduce blood usage by at least a few percent, which more than pays for the $19,000 fee to perform a 100 chart review. Upon completion of Phase I, a proposal with detailed cost-benefit analysis will be submitted to the hospital to perform Phase II UR.

Phase II: Intensive Utilization Review

Intensive IEUR of all hospital transfusion charts (or other services) will be completed for typically four to eight months. Because 100% review will cause a likely reduction in utilization, IEUR generates a virtually immediate return on investment. Phase II IEUR is provided on a fee-per-chart basis that is based on the costs associated with chart processing. For example, the fee-per-chart to process paper records is higher than the fee to process electronic chart data that doesn’t require as much manual processing. The fee for Phase II IEUR is expected to be $150 per chart or less. The direct cost saving alone in the case of blood usage exceeds $150 per chart. There is also an expected reduction in the number of patients receiving blood which reduces the number of patients needing review. Consequently, an instantaneous positive return on investment can be realized.

Phase III: Maintenance Utilization Review

As hospital services become more efficient and appropriate, intensive IEUR is replaced by a maintenance program that reviews a smaller sample of charts. This will progressively reduce the number of charts reviewed from 100 to 50 to 20 to 10 to 5 percent as appropriate, in order to provide optimal cost-efficiency. IEUR constantly monitors the most high-risk utilization in order to quickly identify, monitor and correct instances of less than optimal use. Other utilization review projects may be simultaneously added to continually enhance hospital operation and patient care. As patient care becomes much more efficient, less work is required to critique services and consequently the cost continues to decline.