Managing Managed Care

Our inequitable, inefficient, oftentimes uncaring health care "system," revealed. -- Jeffrey G. Kaplan, M.D., M.S.

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Saying No, Well

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Clearly, not fulfilling patients' requests diminishes their satisfaction, but patient-centered communication can enhance that. So what is one to do? Being adept at saying "no" is an art; it should preserve, if not amplify a practitioners' interest in and concern for their patient. This article describes ways of negotiating with patients about specific requests for diagnostic testing, treatment, on-going or changing care.

The Way of Malpractice

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Getting sued for malpractice can make any practitioner overly practice defensively, which is not the same as more effectively and certainly not more cost-effectively.  Abstract "Despite widespread agreement that physicians who practice defensive medicine drive up health care costs, the extent to which defensive medicine increases costs is unclear. The differences in findings to date stem in part from the use of two distinct approaches for assessing physicians' perceived malpractice risk.

Dysfunctional Liability System

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See Defensive medicine has been highlighted as a major driver of health care costs here and elsewhere.  It probably is when you consider the indirect costs (how it changes the way we practice).   Along comes the Accountable Care Organization Are ACOs Subject to More or Less Liability? Yes, and it is instructive to review why and how they are different.

Quality/Cost, International Comparisons -- OUCH!

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The following lists are from  Note that the US ranks at the bottom of 19 industrialized countries in preventable deaths/100,000 population. Top 25 countries with the best healthcare systems The Top 10 Medical Travel Destinations How the Performance of the U.S. Health Care System Compares Internationally (Health Expenditures/Capita) Health Expenditures per Capita - Seven Selected Countries

What's Non-emergent?

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Non-emergent? There are 2 schools of thought in health care cost-efficiency management: One is benefit limitation and the second is managing "non emergent" presentations with a triage payment for screening the patient. The following is a snippet from Charita Harmon, her LinkedIn MCO Executive discussion:

Protecting Practitioners With Compliance Programs

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When addressing possible administrative sanctions, an effective compliance program (CP) can protect physicians, so long as it was in place predating any investigation.  The burden, however, is on the physician practice to demonstrate that their CP is operational, effective and meaningful. 

Health Care Reform at the Office

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Francis J. Crosson, MD seeks "a rationale designed to influence the physician microenvironment so as to support physicians in developing patterns of clinical decision making that result in better health outcomes and lower costs."