Physicians feel effects of utilization review in practices

Article Abstract:

Utilization review by health insurance companies and peer review organizations, according to a study by the American Medical Association's Center for Health Policy Research, affects over 70% of surgeons and almost 50% of all physicians each month. Utilization review by third-party providers may actually increase healthcare costs because it duplicates peer reviews. However, the switch to outpatient care brought about by utilization review has significantly reduced costs.

Evaluation, Surveys, Physician services utilization

---

Putting physicians behind bars: fraud crackdown holds doctors to higher standards

Article Abstract:

Health professionals are receiving prison terms in fraud prosecutions, while hospital administrators may be rewarded for giving evidence. For example, in the case of National Medical Enterprises Inc., a psychiatric counselor went to prison for eight years, but the executive who devised the fraud scheme received probation. US Attorney Paul Coggins upholds more severe penalties for physicians and other professionals because they are betraying a trust.

Hospitals, Specialty outpatient clinics, not elsewhere classified, Outpatient Mental Health and Substance Abuse Centers, Physicians & Surgeons, Offices of Physicians (except Mental Health Specialists), Mental Health Care, Interpretation and construction, Cases, Mental health services, Fraud, Medical ethics, Psychiatric hospitals, National Medical Enterprises Inc., NME

---

High-tech home care dilemma; physicians face payment struggle to get patients out of the hospital

Article Abstract:

Doctors are rarely adequately reimbursed for home care services to acutely ill patients despite research demonstrating its safety and effectiveness. Medicare, for example, will not pay for home antibiotic therapy, the most common home infusion therapy. Health maintenance organizations, large commercial health insurance companies and self-funded plans are the most likely to pay for home services, which can cost 30% to 50% less than hospital care.

Laws, regulations and rules, Compensation and benefits, Health insurance industry, Home care services

Similar abstracts:

• Abstracts: Mutations in the precore region of hepatitis B virus DNA in patients with fulminant and severe hepatitis. A hepatitis B virus mutant associated with an epidemic of fulminant hepatitis
• Abstracts: Relation between malpractice claims and adverse events due to negligence: results of the Harvard Medical Practice study III
• Abstracts: Pivotal role of early and sustained infarct vessel patency in patients with acute myocardial infarction. Intracranial hemorrhage after use of tissue plasminogen activator for coronary thrombolysis
• Abstracts: Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. Efficacy of carotid endarterectomy for asymptomatic carotid stenosis
• Abstracts: Geographic variation in the management and outcome of patients with AIDS-related Pneumocystis carinii pneumonia

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.