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ForwardInpatient vs. Observation: Determining Level of Care
Activity description
The distinction between inpatient versus observation status is not always clear-cut. Hospital admission decisions are inherently complex clinical judgments formulated by physicians after careful consideration. Under the Two-Midnight Rule, established by the Centers for Medicare & Medicaid Services (CMS), hospital inpatient admissions are considered reasonable and necessary for patients whose stays cross two midnights. MCG and InterQual guideline criteria use evidence-based screening tools designed to help in clinical decision-making scenarios. This activity will examine available guidelines, tools and resources to support clinical decision-making across the continuum of care.
Course last reviewed: 5/22/2023
Provided by
This activity is provided by OptumHealth Education and Optum Care.
Commercial support
No commercial support was received for this activity.
Hardware/Software Requirements
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Target Audience
This activity is designed to meet the educational needs of nurses and physicians interested in guidelines and resources that support clinical decision-making.
Learning Objectives
At the end of this educational activity, participants should be able to:
- Recall the Medicare Hierarchy used for acute care determinations.
- Describe and apply the Two-Midnight Rule in clinical case management.
- Implement MCG or InterQual Inpatient and Observation guidelines correctly for clinical decision-making scenarios.
Faculty/Planners
Sarah Chart, RN
Vice President
OptumHealth Education
Rebecca Gleason, RN, CCM
Clinical Planner
OptumHealth Education
Lolly Bilous, MSN, RN, CCM
Training Consultant
Clinical Adherence and Remediation
Clinical Consistency and Safety
Clinical Performance
Optum Care
Lewis Gregory, MD, MBA
National Medical Director
Clinical Affordability
Optum Care
Vincent Huerta, MD
Senior Medical Director
WellMed, Optum Care
Charles Parente, MD
Medical Director
Optum
Howard Siegel, MD
Medical Director
Optum
Valerie Ventura, MSN, RN
Vice President
Clinical Adherence and Remediation
Clinical Consistency and Safety
Clinical Performance
Optum Care
Tiffany Younts, MSN, RNC-OB, CCM
Training Consultant
Clinical Adherence and Remediation
Clinical Consistency and Safety
Clinical Performance
Optum Care
Disclosures of relevant financial relationships
In accordance with the Accreditation Council for Continuing Medical Education's (ACCME) Standards for Integrity and Independence in Accredited Continuing Education, OptumHealth Education (OHE) requires all those in control of educational content to disclose their financial relationships with ineligible companies within the prior 24 months. Ineligible companies are defined by the ACCME as companies whose primary business is producing, marketing, selling, re-selling, or distributing health care products used by or on patients. Individuals must disclose all financial relationships, regardless of the amount, with ineligible companies and regardless of their view of the relevance of the relationship to the education. OHE ensures that the content is independent of commercial bias.
The activity faculty or planners have no financial relationships to disclose.
Method for calculating CE credit
CE credit was calculated by the complexity of content.
Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by OptumHealth Education and Optum Care. OptumHealth Education is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE) and the American Nurses Credentialing Center (ANCC), to provide continuing education for the health care team.
Credit Designation Statements
Nurses
The participant will be awarded up to 0.50 contact hours of credit for attendance and completion of supplemental materials.
Nurse practitioners
The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts credit from organizations accredited by the ACCME and ANCC.
Physicians
OptumHealth Education designates this enduring activity for a maximum of 0.50 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
PAs
The American Academy of Physician Assistants (AAPA) accepts credit from organizations accredited by the ACCME.
Attendance
A certificate of attendance will be provided to learners upon completion of activity requirements, enabling participants to register with licensing boards or associations that have not been pre-approved for credits. To apply for credit types not listed above, participants should use the procedure established by the specific organization with which they wish to obtain credit.
Available Credit
- 0.50 AMA - Physicians
- 0.50 ANCC - Nurses
- 0.50 Attendance - General Attendance
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