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Author: Institute of Medicine Publisher: National Academies Press ISBN: 0309040485 Category : Medical Languages : en Pages : 321
Book Description
Utilization management (UM) has become a strong trend in health care cost containment. Under UM, some decisions are not strictly made by the doctor and patient alone. Instead, they are now checked by a reviewer reporting to an employer or other paying party who asks whether or not the proposed type or location of care is medically necessary or appropriate. This book presents current findings about how UM is faring in practice and how it compares with other cost containment approaches, with recommendations for improving UM program administration and clinical protocols and for conducting further research.
Author: Institute of Medicine Publisher: National Academies Press ISBN: 0309040485 Category : Medical Languages : en Pages : 321
Book Description
Utilization management (UM) has become a strong trend in health care cost containment. Under UM, some decisions are not strictly made by the doctor and patient alone. Instead, they are now checked by a reviewer reporting to an employer or other paying party who asks whether or not the proposed type or location of care is medically necessary or appropriate. This book presents current findings about how UM is faring in practice and how it compares with other cost containment approaches, with recommendations for improving UM program administration and clinical protocols and for conducting further research.
Author: Stefani Daniels Publisher: ISBN: 9781556452147 Category : Hospital utilization Languages : en Pages : 0
Book Description
The Hospital Guide to Contemporary Utilization Review is a comprehensive resource designed to identify utilization review (UR) best practices and provide guidance on developing and enhancing a contemporary UR committee. This book focuses on the latest UR and patient status requirements to help hospitals perform high-quality reviews and comply with regulations. The book covers a range of topics, including compliance with the UR Condition of Participation, legal obligations of a hospital, contract language, and compliant UR plan language to provide an understanding of the expectations of a UR program. Tips for intradepartmental collaboration are included to guide professionals through the process of selecting a physician advisor and partnering with nurses, case managers, and revenue cycle team members. This book will help you do the following: Identify the components of a best practice hospital utilization review (UR) program Describe the legal obligations of the hospital to comply with chapter 42 CFR 482.30 of the Conditions of Participation (CoP) Use the publication as a tool to assess his or her own hospital's UR processes Summarize the benefits of a dedicated UR team to promote compliance with the CoP Facilitate the development of a contemporary UR committee Assess an organization's opportunities to improve processes to benefit patient care and hospital success Recommend compliant language for the organization's UR plan Construct commercial contract language, in collaboration with the organization's contract manager, that promotes a partnership to ensure appropriate use of acute care resources Seek out operational resources to perform high-quality reviews that fully comply with the CoP Explain the connection between a good utilization review plan and the hospital revenue cycle initiatives
Author: Navarro Publisher: Jones & Bartlett Publishers ISBN: 076378883X Category : Medical Languages : en Pages : 659
Book Description
Managed Care Pharmacy Practice, Second Edition offers information critical to the development and operation of a managed care pharmacy program. The text also covers the changes that have taken place within the delivery of pharmacy services, as well as the evolving role of pharmacists.
Author: Donald S. Shepard Publisher: World Health Organization ISBN: 9789241545280 Category : Medical Languages : en Pages : 106
Book Description
A practical guide to the principles and methods of cost analysis as a managerial tool for improving the efficiency of hospitals. Addressed to managers and administrators, the manual aims to equip its readers with the knowledge and skills needed to calculate the costs of different activities or departments, analyse their significance, and use this information to manage resources wisely. Throughout, recommendations and advice are specific to the different purposes of cost analysis and the different types of decisions commonly facing managers. The manual, which is intended for use as a training tool, was finalized following extensive field testing in workshops in Bangladesh, Egypt, and Zimbabwe. Methods of cost-finding and cost analysis are thoroughly explained and illustrated with practical examples and model step-by-step procedures for performing calculations. Since hospital accounting systems in developing countries may have gaps or inaccuracies, the manual gives particular attention to reliable methods for estimating costs when existing data are problematic. The manual opens with an explanation of the many advantages of using cost-finding and cost analysis as managerial tools. These include the provision of data needed for informed decisions on operations and infrastructure investment, the planning of future budgets, the establishment of charges for patient services, and the development of mechanisms for ensuring that costs do not exceed available revenues and subsidies. Against this background, the core of the manual is presented in three chapters. The first and most extensive chapter explains how to allocate costs to cost centres and how to compute unit costs. Information and examples are presented according to seven steps. Each is discussed in terms of the types of data needed, how component cost items should be treated, and how costs can be computed in particular situations or cases. Practical examples are used to illustrate the types of questions addressed in cost analysis and the value of this information in guiding decisions. Chapter two explains how cost data can be used to improve the management of an individual hospital. Information is intended to guide decisions at both the cost centre, or department, level and the hospital level. Managerial tasks covered include budgeting, profitability, efficiency improvements, contracting outside services or producing in-house, and assessing fiscal solvency. Chapter three considers the use of cost data in managing national and regional hospital systems. Specific applications include improvements in the referral system, the appropriate use of different providers of services, and the comparison of similar hospitals to identify inefficiencies or sources of waste. The manual concludes with a series of practical exercises, followed by explanations of their answers.
Author: Kent Lewandrowski Publisher: Springer ISBN: 3319341995 Category : Medical Languages : en Pages : 299
Book Description
This book is the first comprehensive text on utilization management in the clinical laboratory and other ancillary services. It provides a detailed overview on how to establish a successful utilization management program, focusing on such issues as leadership, governance, informatics, and application of utilization management tools. The volume also describes ways to establish utilization management programs for multiple specialties, including anatomic pathology and cytology, hematology, radiology, clinical chemistry, and genetic testing among other specialties. Numerous examples of specific utilization management initiatives are also described that can be imported to other heath care organizations. A chapter on utilization management in Canada is also included. Edited by an established national leader in utilization management, Utilization Management in the Clinical Laboratory and Other Ancillary Services is a valuable resource for physicians, pathologists, laboratory directors, hospital administrators, and medical insurance professionals looking to implement a utilization management program.
Author: Institute of Medicine
Author: Institute of Medicine
Author: Robert Miller
Author: Field MJ Gray BH (editors)
Author: Institute of Medicine
Author: Stefani Daniels
Author: Navarro
Author: 
Author: Donald S. Shepard
Author: David W. Young
Author: Kent Lewandrowski