Indigent Care Services
Evaluating quality of care for indigent populations
TMF Health Quality Institute provides ongoing assessment of the utilization and quality of health care services provided to indigent clients for county hospital districts. Our expert data gathering and analysis services help governmental entities and agencies provide a higher quality of care for patients and a more effective use of resources for programs they administer.
Using nationally recognized screening criteria, TMF conducts consistent and accurate third-party medical record review. We can supply data on appropriate use of inpatient hospital services, quality of care provided and correctness of billing codes submitted. Our nurse reviewers are experts in utilization and quality review, and our senior consultants provide thorough analysis and recommendations to improve the efficiency and quality of health care systems. We offer an unbiased, third-party assessment of:
- Medical necessity
- Quality of care
- Admission vs. observation status
- Appropriate coding and billing
- Patient care patterns and trends
TMF has more than 125 physician reviewers representing more than 60 specialties, allowing us to appropriately assign physicians to each medical case.
Services
- No-fee initial program evaluation to identify probable areas of quality issues or improper utilization of services
- Further evaluation of quality and proper utilization of services
- Data collection, analysis and reporting
- Recommendations for performance and quality of care improvements
- Assessment of the following areas: inpatient, outpatient, emergency room, ambulatory surgery, observation, primary care clinic and dental clinic
Clients
Currently TMF holds contracts to assist with indigent care programs in the following hospital districts:
- Nueces County – We provide ongoing assessment and analysis of quality of care provided to indigent clients, as well as data on cost effectiveness of services and over/underutilization patterns.
- Montgomery County – We present health care review information to the hospital district board and its health care partners and assist with reducing inappropriate utilization of services.
- Williamson County – We provide ongoing assessment and analysis of quality of care provided to indigent clients and have performed a study on patient admission patterns.
Accomplishments
- TMF provides data that allow districts to make administrative decisions that change care processes to improve quality, decrease cost and increase the availability of services. For example, one district used data from TMF’s review of indigent care services to reduce rates of one- and two-day admissions by 50 percentage points and medically unnecessary back surgeries by 10 percentage points.