Preadmission Screening of Medicare Patients: The Clinical Impact of Reimbursement Disapproval

The clinical impact of a statewide Medicare preadmission certification program was assessed with a retrospective survey of Connecticut physicians. In a three-month period, only 100 (0.37%) of 28 450 Medicare admission requests were disapproved for reimbursement. Following disapproval, 22 patients were admitted immediately, 44 received outpatient care, and eight additional outpatients were not evaluated or treated. The remaining 26 patients subsequently were admitted with preadmission approval due to changed clinical condition or failed outpatient plan. Although some patients had minor problems that their physicians believed would have been avoided by immediate admission, no severe morbidity resulted from admission delay. Many physicians expressed concern about preadmission certification program—related patient anxiety and inconvenience. Although this limited survey provides preliminary evidence that preadmission certification programs can be implemented without major deleterious short-term medical effects, continued monitoring of physicians and patients involved in disapproved admissions is necessary to evaluate potential medical and psychosocial problems. ( JAMA 1988;259:3418-3421)