What Is InterQual? How Does it Help in Healthcare Management?

When patients need hospitalization, case management, and utilization staff utilize InterQual criteria as a screening tool to aid doctors in selecting the right level of care for the patient.

What is InterQual criteria? The InterQual Criteria are a collection of clinical signs that may be measured, together with therapeutic and diagnostic interventions, that are used to determine whether or not a patient requires hospitalization. They are not based on the diagnosis of the patient; rather, they take into account the degree of disease of the patient and the services that are necessary; as a result, they serve as the criteria for all sorts of hospital treatment, notwithstanding the size or location of the hospital.

In this article, we will discuss what is InterQual, its sets of criteria, and the various benefits it has to offer in healthcare management.

The criteria are organized into 14 different body systems, and for each body system, there are three different sets of criteria:

  1. Intensity of Service
  2. Severity of Illness
  3. Discharge Screens

The Intensity Severity Discharge Level of Care Criteria are used to assess whether or not an individual should be admitted, whether or not continuous treatment should be provided, and whether or not they should be discharged. ISD employs objective clinical indicators to establish the right level of care for a patient, taking into account the severity of their condition and the specific needs of their care, as well as to recommend the most suitable care environment for them. ISD is used by healthcare organizations all around the globe as a way of putting a halt to overutilization, preventing underutilization, and managing financial risk using clinically acceptable measures. The knowledge base of the individual physician is designed to be complemented and supported by ISD.

The Clinical Decision Support Criteria may assist you in ensuring not only the suitability of medical treatments but also the efficient management of associated costs. They have shown success as a demand management technique. InterQual Criteria, which are centered on clinical appropriateness, are a distillation of the best medical practices into practical instruments for directing, monitoring, and recording choices made at the point-of-care level.

Benefits of InterQual Criteria

Benefits of InterQual Criteria
  • Medicine based on evidence, which takes into account the most recent medical literature
  • The most effective and generally acknowledged methods of medical treatment
  • Based on clinical evidence and tailored to the individual patient
  • The InterQual Criteria are derived from the most recent, evidence-based information that can be found in the published medical literature as well as the generally acknowledged best practices for medical treatment
  • The criteria have a significant clinical component and may be used in a targeted manner to case studies
  • Review and testing of the criteria occurs on a continuous basis, and revisions are made available for publication every six months, with the most significant release being in April of each year
  • The use of rules makes it possible to conduct consistent and repeatable reviews, which may also be referred to as credible reviews
  • Objective, based on established rules, and trustworthy
  • Triages patient treatment to a degree of clinical appropriateness
  • Provides safeguards against both the excessive and insufficient use of therapeutic resources
  • Facilitates satisfying regulatory requirements
  • Additional advantages include assisting in the process of appropriately assigning patients to the right level of care and reducing both the excessive and insufficient use of healthcare resources
  • The regulatory requirements, such as the standards established by The Joint Commission and the quality measurements established by NCQA, are also included into the criterion
  • It is possible to combine and analyze the data obtained from all evaluations in order to look for patterns and trends related to resource consumption. This information may be put to use in the operational decision-making process for ongoing efforts including analysis, assessment, education, and process improvement
  • In managing healthcare resources in accordance with the three pillars that make up the Healthcare Management Triad, the criteria helps both healthcare providers and payers
  • Permits the gathering of data, the reporting of review results, and the making of decisions pertaining to operational matters
  • Includes all three components of healthcare management

The Bottom Line

Training and implementation programs for the various InterQual products are made accessible to all licensees. There is a wide variety of delivery options available, which allows for the satisfaction of virtually any requirement.

If you have any queries related to the InterQual criteria, please feel free to contact us.

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