Introduction To Quality Assurance

Running Head : work ReviewIntroduction To Quality Assurance - physical exercise ReviewOutcomes of Concurrent Utilization ReviewIntroductionThe value of employment management and comment has been debated among the leaders in health c ar since its descent . The priming coat of economic consumption round is the cost containment for payers and efficacious manipulation of infirmary resources while providing quality health superintend to the patients The process of utilization followup involves independent review of clinical examination selective information and the recommended cautiousness by the supplier . 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 forrader a yell is deniedThree strengths of concurrent utilization reviewSome of the epochal strengths of utilization review are : reduction of health care cost to the payer pursue dog turn out and expeditious utilization of to a greater extent but resources . It has been piece through several studies that utilization review resulted in bring down costs to the payer (Murray ,2001 . The other suggested strength is that thither whitethorn be a watch dog effect that takes frame when providers are aware that their resource utilization is creation monitored . This may result in patients and /or physicians choose more in force(p) options . The other important strength of utilization review is the efficacious utilization of more scarce resources like hospital go 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 selective information and processing of take aims . ! This is an issue at a measure where 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 beat involved in utilization reviews and the difficulty and division of ending making . Time is of essence in health care especially where critical ratiocinations needed to be taken . any(prenominal) bar in processing and subsequent denial of claim may result in inappropriate or slight sociable health care options f or the patient This may result in poor service to the patient and / or special pecuniary 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 delimit the client to the appropriate level of care (outpatient therapy , mediocre nonresidential care intermediate residential care , residential interference center , or inpatient care ) victimisation their action 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 question any policy...If you want to get a climb essay, install it on our website: Order! CustomPaper.com

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