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MCAP™ Admission and Discharge Criteria Benefits

MCAP™ Admission and Discharge Criteria is Focused on Care Needs, Not Diagnosis

MCAP Criteria are superior because, unlike any other Care and Resource Utilisation (CRU) product, they are focused on patient needs. MCAP uses the intensity of services delivered to the patient based on the patient’s severity of illness to accurately determine the best level-of-care for patient placement.

Using the CRU MCAP System, reviewers focus on the level-of-care and the services that a patient requires on a particular day, not on the patient’s diagnosis. For medical surgical cases, for example, pneumonia patientssharing a common diagnosis may have widely differing needs. By weighing the care needs, the CRU MCAP System will indicate that a less costly setting is appropriate if frequent observation or intense respiratory care is not required. In this case, the patient could be appropriately and safely served at an alternative level-of-care, rather than in an acute-care general hospital. For behavioural health cases, for example, a patient with risk to harm self may be treated at various levels-of-care. By assessing the risk and the services needed to contain the risk, the CRU MCAP System will indicate whether the patient requires a secure, structured inpatient psychiatric setting, or may be safely treated in a less intensive level-ofcare, e.g., partial hospital. In both examples, not only are there potential cost savings but quality of patient care is enhanced as patients treated at the correct level-of-care get the most focused services, decreasing the change of adverse outcomes.

MCAP™ Admission and Discharge Criteria is Structured and Evaluative, Not Directive

The CRU MCAP System provides criteria in a logical, intuitive manner that complements reviewers’ medical/psychiatric knowledge. CRU MCAP relies upon a structured and guided evaluative approach, with discrete decision points; not on arbitrary parameters. Thus, the CRU MCAP System reviews make clinical sense and do not create delays while clinicians seek out lab reports or other information to populate a rigid decision tree. This structured approach promotes reviews that are consistent among reviewers, consistent between reviews of similar cases, and supportable. In many cases, the criteria prompt discussions with physicians about treatment alternatives that could be provided in a less costly setting without compromising quality. This feature of the CRU MCAP System promotes a collegial relationship between review staff and physicians; something very different from other CRU products.

MCAP™ Admission and Discharge Criteria is Predictive of Physician Review Results

A recent independent study found that when using the MCAP Criteria, a reviewer’s first decision is most often the correct decision. Less than 2% of all cases reviewed using MCAP Criteria are overturned upon further physician review. This level of inter-rata reliability has assisted our clients to be confident in making process changes and ensures benchmarking studies have face validity. Because of the practical approach of the CRU MCAP System, it assists physicians in evaluating their patient placement decision making process through logic and understanding, not by the use of rigid data parameters that may be completely without merit.

In summary, the MCAP™ Admission and Discharge Criteria:

  • Determine the most clinically suitable level-of-care required to treat a patient safely and efficiently based on services needed;
  • Are used by health care providers to determine if a patient requires hospitalisation;
  • Provide a resource to medical judgement when determining the
    required level-of-care, and
  • Are applicable across the continuum of care and comprise both
    Medical/Surgical and Behavioural Health criteria sets.