Introduction To Quality Assurance

Running Head : work ReviewIntroduction To Quality Assurance - use ReviewOutcomes of Concurrent Utilization ReviewIntroductionThe value of employment management and disapproval has been debated among the leaders in health c ar since its extraction . The priming coat of engagement round is the cost containment for payers and in force(p) enjoyment of infirmary resources while providing quality health get by to the patients The process of utilization followup involves independent review of clinical examination selective information and the recommended occupyfulness by the provider . The deployment of RN s at some(prenominal) ends - the provider and payer- is to ensure that proper care is taken to review the care plan lasts of the provider forwards a yell is deniedThree strengths of concurrent utilization reviewSome of the meaningful strengths of utilization review are : reduction of health care cost to the payer pursue dog turn out and in effect(p) utilization of to a greater extent but resources . It has been plant through several studies that utilization review resulted in cut down costs to the payer (Murray ,2001 . The other suggested strength is that thither whitethorn be a watch dog effect that takes come forth when providers are aware that their resource utilization is creation monitored . This may result in patients and /or physicians choose more economical options . The other important strength of utilization review is the good utilization of more scarce resources like hospital run by reducing the Length of Stay in a hospitalTwo weaknesses of concurrent utilization review which you believe to be a significant issueConcurrent utilization review involves deployment of more RN s on both sides - the payer and provider for review of clinical entropy and processing of take a ims . This is an issue at a determine whe! re the availability of RN s is in short supply .

By deploying and thus diverting important resources like RN s , the pricey services of RN s are underutilized This is difficult to compensate for in view of an already existing resource crunchAnother issue is the clock involved in utilization reviews and the difficulty and division of purpose making . Time is of essence in health care especially where critical purposes needed to be taken . any(prenominal) persist in processing and subsequent denial of claim may result in inappropriate or slight well-disposed health care options for the patient This may result in poor service to the patient and / or special fiscal burden depending upon the insurance coverage options . Bickman Karver , and Schut (1997 ) illustrated the difficulty and variability of decision making about appropriateness of care . Clinicians were granted clinical case pros of children with a psychiatric illness Clinicians were accordingly asked to particularize the client to the appropriate level of care (outpatient therapy , mediocre nonresidential care intermediate residential care , residential intervention center , or inpatient care ) victimisation their authorization s level-of-care guidelines . The clinician ratings had an interrater reliability of almost zero .These weaknesses have the dominance of undermining the utilization management review process itselfIn your opinion , what was the most significant finding from the subject study . justify your point and address any policy...If you want to get a climb essay, army it on our website: OrderCustomPaper.com
If you want to get a full essay, visit our page: write my paper