Mcg guidelines12/18/2023 Hospitals also use the “Case Management” and “Extended Stay” sections to help them actively manage patients through to discharge or transition to another level of care. The “Optimal Recovery Course” identifies key care elements and milestones in patient recovery to ensure that the safest and most appropriate care is being given. Milliman’s Care Guidelines are designed for both retrospective and concurrent review, meaning both QIOs and hospitals can use them to determine the appropriateness of admission and appropriateness of inpatient care. “With the Care Guidelines we look at the patient’s entire continuum of care, thereby improving our ability to evaluate a hospitalization based upon the patient as a whole, rather than fragments of clinical information. “Our previous screening criteria limited our review to evaluating a patient’s need for inpatient care at a particular moment in time,” said KFMC review staff Toni Pierson, RN and Diane Dudley. The Kansas QIO, Kansas Foundation for Medical Care (KFMC), has been using the Milliman Care Guidelines since summer 2002 for both Medicare and Medicaid reviews. “Milliman’s Care Guidelines surpass CMS requirements, and our free program opens much broader access to the evidence-based clinical tools that can improve the quality of care provided.” “Now that CMS has confirmed the QIOs’ ability to choose the criteria they think best serves their needs, we have moved quickly to give QIOs access to this leading tool,” said Scott Harris, Marketing and Sales Director for Milliman Care Guidelines. The free program means that QIOs will now have access to the criteria used by most commercial insurers, which will help streamline the quality and appropriateness reviews in hospitals.
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