Is it the patient's fault when they end up getting needed care out-of-network, i.e., from physicians who aren't part of the managed care network, the referral list is too thin or restrictive, the right specialist is elsewhere (or so it seems), or simply because there was no opportunity to choose an in-network doctor? Referrals Tell Us a Great Deal About Collaboration Among Practitioners
Coding systems that support clinical decision-making and 'measurement and management,' the modus operandi of Managed Care.
Who's not anxious to improve health care's Cost/Quality/Access lest they be left out?
Lower Respiratory Tract Infections and Inappropriate Antibiotic Use
It's disheartening; the cure for the ills of U.S. health care lies within our grasp, yet it eludes us. We cannot answer basic questions–What works? What we are paying for? Are we getting what we need? Are we getting the right care at the right time and place? QI and UM: Strange bedfellows, but both need data to communicate
The "areas in which the proper reform measures could generate savings that could pay for universal coverage" include, but are not limited to unecessary and presumably unhelpful care, fraud and from the perspective of the physician, extraneous administrative expenses. Unnecessary care is believed to be responsible for as much as 30% of health care spending,2 or up to $830 billion this year alone.
The cost of health care is already dear and rising exponentially while its "value" or the return on investment diminishes. What can be done?
Your health plan or doctor's office seems to see your heart attack, broken leg or laceration differently than you do. They may want you to pay for that which one would ordinarily believe is covered. In general, that is what consumer advocate, Ralph Nader calls "The Crime of Overbilling Healthcare." [Pub online August 31, 2014]
"I don't understand why health care and insurance companies keep appearing in the same sentences." (Fisher, W. Truthout 10/25/09) Isn't it frustrating to have to live under employment based health care insurance? If you lose your job, your employer wants to cut back, or you are a peasant, you're screwed! Also, as a result of the way we are paid and the insurance model itself, there are many forces today that steal us away from the exam table or bedside.
Autism Spectrum Disorders (ASDs) From the American Psychiatric Association's Diagnostic and Statistical Manual-IV, Text Revision (DSM-IV-TR), which provides standardized criteria to help diagnose ASD. Diagnostic Criteria for 299.00 Autistic Disorder A. Six or more items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3): 1. qualitative impairment in social interaction, as manifested by at least two of the following: