America's Health Care Safety Net

America's Health Care Safety Net
Author: Institute of Medicine
Publisher: National Academies Press
Total Pages: 304
Release: 2000-09-04
Genre: Medical
ISBN: 030906497X

America's Health Care Safety Net explains how competition and cost issues in today's health care marketplace are posing major challenges to continued access to care for America's poor and uninsured. At a time when policymakers and providers are urgently seeking guidance, the committee recommends concrete strategies for maintaining the viability of the safety netâ€"with innovative approaches to building public attention, developing better tools for tracking the problem, and designing effective interventions. This book examines the health care safety net from the perspectives of key providers and the populations they serve, including: Components of the safety netâ€"public hospitals, community clinics, local health departments, and federal and state programs. Mounting pressures on the systemâ€"rising numbers of uninsured patients, decline in Medicaid eligibility due to welfare reform, increasing health care access barriers for minority and immigrant populations, and more. Specific consequences for providers and their patients from the competitive, managed care environmentâ€"detailing the evolution and impact of Medicaid managed care. Key issues highlighted in four populationsâ€"children with special needs, people with serious mental illness, people with HIV/AIDS, and the homeless.

Negotiating Managed Care

Negotiating Managed Care
Author: Michael A. Fauman
Publisher: American Psychiatric Pub
Total Pages: 129
Release: 2008-08-13
Genre: Medical
ISBN: 1585627666

For many psychiatrists and other mental health professionals, the clinical review is the most burdensome and disagreeable part of managed care. In that review they are asked, by a representative of the managed care company, to justify their patient's need for care and to defend the treatment they are providing. Clinicians usually feel at a disadvantage in these discussions because they are never quite sure what information the reviewer needs to approve the patient's care. This does not have to be the case. The goal of this book is to teach psychiatrists, mental health professionals, and administrators how reviewers think and how to conceptualize, present, and document clinical care in a manner that greatly increases the likelihood that reviewers will approve their request for care. Beginning with five questions that must be answered in every managed care review, the author discusses the following key topics and many others. Presenting your case to a reviewer -- How to effectively present requests for inpatient, partial hospital, and substance abuse care and avoid common mistakes that decrease the likelihood that your request will be approved. How to answer the four clinical questions that must be addressed in every review even if they are not asked by the reviewer. Negotiating with the reviewer -- How to negotiate with a reviewer who is reluctant to approve the care you request. Writing effective notes -- How to write effective clinical notes in the patient's record that substantiate your request for care and increase the likelihood that it will be approved. Dealing with unethical reviewers -- How to identify and take action against unethical reviewers and managed care companies that are insensitive to your patient's clinical needs. Appealing denials of care -- How to appeal denials of care when you do not agree with the reviewer's decision. These and many other important issues are highlighted in brief vignettes illustrating a clinician's presentation of a patient's case and a typical reviewer's comments. This tremendously useful volume will be welcomed by every mental health care practitioner who must negotiate the current managed care landscape.

Year 2000 and Medicare

Year 2000 and Medicare
Author: United States. Congress. House. Committee on Government Reform. Subcommittee on Government Management, Information, and Technology
Publisher:
Total Pages: 234
Release: 1999
Genre: Computers
ISBN:

Health-Care Utilization as a Proxy in Disability Determination

Health-Care Utilization as a Proxy in Disability Determination
Author: National Academies of Sciences, Engineering, and Medicine
Publisher: National Academies Press
Total Pages: 161
Release: 2018-04-02
Genre: Medical
ISBN: 030946921X

The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.

Understanding and Negotiating Book Publication Contracts

Understanding and Negotiating Book Publication Contracts
Author: Brianna Schofield
Publisher:
Total Pages: 280
Release: 2018
Genre: Authors
ISBN:

"Copyright law and contract language are complex, even for attorneys and experts. Authors may be tempted to sign the first version of a publication contract that they receive, especially if negotiating seems complicated, intimidating, or risky. But there is a lot at stake for authors in a book deal, and it is well worth the effort to read the contract, understand its contents, and negotiate for favorable terms. To that end, Understanding and Negotiating Book Publication Contracts identifies clauses that frequently appear in publishing contracts, explains in plain language what these terms (and typical variations) mean, and presents strategies for negotiating "author-friendly" versions of these clauses. When authors have more information about copyright and publication options for their works, they are better able to make and keep their works available in the ways they want"--Publisher.

Getting to Yes

Getting to Yes
Author: Roger Fisher
Publisher: Houghton Mifflin Harcourt
Total Pages: 242
Release: 1991
Genre: Business & Economics
ISBN: 9780395631249

Describes a method of negotiation that isolates problems, focuses on interests, creates new options, and uses objective criteria to help two parties reach an agreement.