“The patient has a severe infection of the hand and is not improving on the current antibiotics,” I explained to the medical director at the insurance company.
“I understand. However, the patient has no elevated white count or fever, and I cannot get it to meet the criteria, so I will have to deny the necessity for the patient to stay in the hospital,” she explained.
I felt my voice rising and …
The slippery slope of utilization management
On April 5, 2021, the federal government mandated that health care providers provide free electronic access to patients’ clinical notes, as part of the 21st Century Cures Act. This includes 8 types of notes spanning outpatient and inpatient arenas. If providers/organizations do not comply with this mandate, they will be subject to fines due to “information blocking.”
This was borne from the OpenNotes movement – which declares itself to promote and …
How medical notes will change if patients get to see them
When the U.S. health care system began, physicians were largely autonomous in selection of medical treatments and their delivery. Patients were treated under a fee for service model. However, over time we began to notice an alarming incline in medical spending which ultimately lead to the development of health maintenance organizations (HMOs). At their inception, HMOs were intended to standardize medical treatment, reduce unnecessary use of resources, and encourage the …
We should teach medical residents health policy. Here’s why.
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