Introduction To Quality Assurance

Running Head : work ReviewIntroduction To Quality Assurance - Utilization ReviewOutcomes of Concurrent Utilization ReviewIntroductionThe value of employment management and criticism has been debated among the leaders in health c ar since its inception . The priming coat of utilization round is the cost containment for payers and efficient utilization of infirmary resources while providing quality health negociate to the patients The process of utilization followup involves independent review of clinical examination selective information and the recommended care 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 before a yell is deniedThree strengths of concurrent utilization reviewSome of the significant strengths of utilization review are : reduction of health care costs to the payer pursue dog turn out and efficient utilization of to a greater extent but resources . It has been found through several studies that utilization review resulted in reduced costs to the payer (Murray ,2001 . The other suggested strength is that thither may be a watch dog effect that takes place when providers are aware that their resource utilization is creation monitored . This may result in patients and /or physicians choose more efficient options . The other important strength of utilization review is the efficient utilization of more scarce resources like hospital services 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 data and processing of take aims . This is an issue at a quantify where the availability of RN s is in short supply .

By deploying and thus diverting important resources like RN s , the expensive services of RN s are underutilized This is difficult to compensate for in view of an already existing resource crunchAnother issue is the time involved in utilization reviews and the difficulty and division of decision making . Time is of essence in health care especially where critical decisions needed to be taken . any(prenominal) delay in processing and subsequent denial of claim may result in inappropriate or slight favorable health care options for the patient This may result in poor service to the patient and / or special financial 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 assign the client to the appropriate level of care (outpatient therapy , mediocre nonresidential care intermediate residential care , residential treatment center , or inpatient care ) victimisation their agency 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 discuss any policy...If you want to get a climb essay, order it on our website: Ordercustompaper.com

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