1. Use the most current information in the Healthcare Cost and Utilization Project (http:// hcupnet.ahrq.gov) database to answer the following questions:
a. What are the nationwide average length of hospital stay and average hospital costs for patients with the following diagnoses?
• Abdominal pain
• Acute myocardial infarction
• Chronic obstructive pulmonary disease and bronchiectasis
• Diabetes mellitus with complications
b. What are the nationwide average length of hospital stay and average hospital costs for patients who underwent the following procedures?
• Cesarean section
• Hip replacement, total and partial
• Hysterectomy, abdominal and vaginal
• Percutaneous coronary angioplasty (PTCA)
c. If data are available for your state, what are your state’s average length of hospital stay and average costs for patients with the diagnoses in (a) and for patients who
underwent the procedures in (b)?
2. A hospital’s UM committee discovers that the rate of cesarean section births at the hospital is higher than the rate at other hospitals in the region. A higher percentage of women
at other hospitals are having vaginal deliveries. The UM committee wants to evaluate the medical necessity of cesarean section births at the hospital using clinical practice guidelines on this topic. Go to the website of the National Guidelines Clearinghouse (www.
guidelines.gov) to find the most current guideline recommendations that address the indications for a cesarean section birth.
3. What UM practices does your health insurance company follow to control costs and ensure provision of medically necessary services? This information may be available in your
insurance benefits booklet or on your health plan’s website. If you do not have health insurance, go to the website of any major health insurance company and list the practices this company follows to control costs and ensure provision of medically necessary
services
