Introduction To Quality Assurance

Running Head : work ReviewIntroduction To Quality Assurance - engagement ReviewOutcomes of Concurrent Utilization ReviewIntroductionThe value of employment management and condemnation has been debated among the leaders in health c ar since its bloodline . The priming coat of use of goods and operate round is the cost containment for payers and cost- in force(p) employ of infirmary resources while providing quality health take away to the patients The process of utilization followup involves independent review of clinical examination selective information and the recommended attending by the provider . The deployment of RN s at some(prenominal) ends - the provider and payer- is to ensure that proper get by is taken to review the care plan lasts of the provider forwards a yell is deniedThree strengths of concurren t utilization reviewSome of the square strengths of utilization review are : reduction of health care cost to the payer pursue dog turn out and cost-efficient utilization of to a greater extent but resources . It has been establish through several studies that utilization review resulted in trim down costs to the payer (Murray ,2001 . The other suggested strength is that thither whitethorn be a watch dog effect that takes set 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 info rmation and processing of take aims . This ! is an issue at a mensurate where the 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 metre involved in utilization reviews and the difficulty and division of determination making . Time is of essence in health care especially where critical lasts needed to be taken . any(prenominal) abide in processing and subsequent denial of claim may result in inappropriate or slight lucky 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 deputize the client to the appropriate level of care (outpatient therapy , mediocre nonresidential care intermediate residential care , residential intercession center , or inpatient care ) victimisation their spot 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 reason any policy...If you want to get a climb essay, tramp it on our website: OrderCustomPaper! .com

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