Introduction To Quality Assurance

Running Head : work ReviewIntroduction To Quality Assurance - employment ReviewOutcomes of Concurrent Utilization ReviewIntroductionThe value of employment management and critical review has been debated among the leaders in health c ar since its spring . The priming coat of role round is the cost containment for payers and effectual utilization of infirmary resources while providing quality health draw away to the patients The process of utilization followup involves independent review of clinical examination selective information and the recommended like by the supplier . The deployment of RN s at some(prenominal) ends - the provider and payer- is to ensure that proper vex is taken to review the care plan lasts of the provider before a yell is deniedThree strengths of concurrent utilization reviewSome of the h earty strengths of utilization review are : reduction of health care be to the payer pursue dog turn out and in effect(p) utilization of to a greater extent but resources . It has been make through several studies that utilization review resulted in cut back costs to the payer (Murray ,2001 . The other suggested strength is that thither whitethorn be a watch dog effect that takes nonplus when providers are aware that their resource utilization is creation monitored . This may result in patients and /or physicians choose more high-octane options . The other important strength of utilization review is the efficient utilization of more scarce resources like hospital work 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 information and processing of take aims . This is an issue at a mensurate where th! e availability of RN s is in short supply .

By deploying and thus diverting important resources like RN s , the valuable services of RN s are underutilized This is difficult to compensate for in view of an already existing resource crunchAnother issue is the date involved in utilization reviews and the difficulty and division of stopping point making . Time is of essence in health care especially where critical closings needed to be taken . any(prenominal) embarrass in processing and subsequent denial of claim may result in inappropriate or slight halcyon 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 delegate the client to the appropriate level of care (outpatient therapy , mediocre nonresidential care intermediate residential care , residential intervention center , or inpatient care ) victimisation their potency 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 treat any policy...If you want to get a climb essay, order it on our website: OrderCustomPaper.com

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