A MEDICAL DIRECTOR'S VIEW
It's one of the most thankless jobs in health care: denying a patient's request for medical treatment. Before making such a decision, follow these steps to avoid bad-faith denials, warns an experienced medical director.
A physician considers California voters' rejection of two managed care reform measures and what it means for the future. Change will continue, he predicts, as consumers "vote" with premium dollars rather than ballots.
For the new director of the Center for Outcomes and Effectiveness Research at the federal Agency for Health Care Policy and Research, putting in one night a week as a practicing internist is a helpful reality check.
Many large institutions, including HMOs, know the advantages of resolving disputes outside the legal system through mediation and arbitration. Physicians, too, can use these procedures to save time and money.
The idea of teamwork pervades health care these days, and it applies in a distinct way to workers' comp, where the physician may be expected to identify fraudulent claims. Fortunately, they're often easy to spot.
As the health care market evolves, physicians will be wise to adopt new ways of dealing with managed care organizations, says this consultant, especially when it comes time to ink capitation contracts.
Having transformed the market, pharmacy benefit management companies are now in for some shaking up themselves. More tightly controlled formularies are one possibility.
When magazines like this one recommend some action to physicians as "worth the time it takes," do you sometimes wonder where the time is supposed to come from? This article may help.
Workers' compensation is attracting managed care companies because they can, more effectively than individual providers, concentrate on what's really important to employers — getting injured workers back on the job.