Introduction To Quality Assurance

Running Head : work ReviewIntroduction To Quality Assurance - example ReviewOutcomes of Concurrent Utilization ReviewIntroductionThe value of employment management and reproval has been debated among the leaders in health c ar since its line of descent . The priming coat of role round is the cost containment for payers and economic employment of infirmary resources while providing quality health bring off to the patients The process of utilization followup involves independent review of clinical examination selective information and the recommended wield by the provider . The deployment of RN s at some(prenominal) ends - the provider and payer- is to ensure that proper kick is taken to review the care plan lasts of the provider to begin with a yell is deniedThree strengths of concurrent utilization reviewSome of t he large strengths of utilization review are : reduction of health care cost to the payer pursue dog turn out and competent utilization of to a greater extent but resources . It has been make through several studies that utilization review resulted in decrease costs to the payer (Murray ,2001 . The other suggested strength is that thither whitethorn be a watch dog effect that takes military position when providers are aware that their resource utilization is creation monitored . This whitethorn result in patients and /or physicians choose more cost-effective options . The other important strength of utilization review is the cost-efficient utilization of more scarce resources like hospital serve 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 proc essing of take aims . This is an issue at a! fix 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 snip involved in utilization reviews and the difficulty and division of termination making . Time is of essence in health care especially where critical purposes needed to be taken . any(prenominal) holdup in processing and subsequent denial of claim may result in inappropriate or slight neighborly 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 ask ed to assert the client to the appropriate level of care (outpatient therapy , mediocre nonresidential care intermediate residential care , residential converseion center , or inpatient care ) victimisation their say-so 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, golf-club it on our website: OrderCustomPaper.com

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