Negotiating Managed Care
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Author | : Richard L Kravitz |
Publisher | : McGraw Hill Professional |
Total Pages | : |
Release | : 2021-07-06 |
Genre | : Medical |
ISBN | : 1260462501 |
Achieve optimal patient outcomes and build positive health care relationships with this timely and essential guide Patient relations, satisfaction, and engagement are more important than ever. Many patients today research their conditions online, and are the targets of marketing campaigns by hospitals, medical device manufacturers, and the pharmaceutical industry. As a result, some will bring a consumer mindset to the exam room and even demand tests and treatments that are of questionable value. This new health care landscape makes the ability to clinically negotiate with patients an increasingly important skill. Understanding Clinical Negotiation helps clinicians navigate patient desires toward mutually defined goals. The first guide of its kind, this important resource will equip clinicians with the insights and pragmatic skills needed to strike the right balance between care and costs, while ensuring the satisfaction and safety of every patient. Understanding Clinical Negotiation features: Real-world vignettes incorporating scenarios encountered in research and practice Clinical pearls and summary bullet points for each chapter Actionable lessons that can be applied immediately in practice Deeper Dive sidebars with additional insights and information Strategies for fostering patients’ full disclosure of relevant information Methods for raising awareness of and managing emotions in clinical care Best practices for collaborative decision-making in diverse populations
Author | : Institute of Medicine |
Publisher | : National Academies Press |
Total Pages | : 384 |
Release | : 1996-11-01 |
Genre | : Medical |
ISBN | : 0309175364 |
Medicare beneficiaries are rapidly moving into managed care, as attempts to restrain the growth of this costly entitlement program progress. However, advocates for patients question whether the necessary information and structures are in place to enable Medicare consumers to select wisely among private-sector managed care options. Improving the Medicare Market examines how to give Medicare beneficiaries the same choice of health plan options enjoyed in the private sectorâ€"yet protect them as consumers and patients. This book recommends approaches to ensuring accountability and informed purchasing for Medicare beneficiaries in an environment of broader choice and managed careâ€"how the government should evaluate and approve plans, what role the traditional Medicare program should play, how to help to elderly understand their options, and many other practical matters. The committee discusses the information requirements of Medicare beneficiaries and explores in detail how best to respond to their special needs. And it examines the procedures that should be developed to provide the necessary protections for the elderly in a managed care system.
Author | : William A. Garofalo |
Publisher | : Jossey-Bass |
Total Pages | : 0 |
Release | : 1999-01-06 |
Genre | : Health & Fitness |
ISBN | : 9780787945817 |
Today's heath care marketplace is highly competitive, requiring managed care providers to contract with dozens of insurers to survive. Each of these contracts comes with their its unique terms and conditions-making the contracting process overwhelmingly complex and giving many health care executives major headaches. Written by three of the country's leading health care consultants and attorneys, Managed Care Contracting is the first book to offer executives with no legal background practical, step-by-step advice on how to create winning contracts between health care organizations, payers, and employers. In straightforward language, free of legalese and jargon, this much-needed resource demystifies managed care contracting and prescribes some critical advice for hospital and physician group practice executives. The authors present helpful guidelines for evaluating the various types of managed care contracts and explain the most significant terms and concepts executives are likely to encounter. A treasure trove of information for health care executives no matter what their experience level, Managed Care Contracting Examines how to develop a contracting strategy Reviews the fundamentals of negotiating the contract Frames the key steps in the contracting process Provides a managed care contract negotiations checklist Dissects sample hospital and physician contracts Analyzes the contract risk factors by the type of payment explores the implications of changing financial incentives Outlines the most up-to-date information in the regulatory environment Includes illustrative examples and helpful tables and chartsFor health care executives who are just beginning the complex contracting process and for the more experienced who require the most current information on the topic, Managed Care Contracting provides the knowledge and tools they need to succeed. "Managed Care Contracting is a very timely
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.
Author | : Steven Babitsky |
Publisher | : Seak Incorporated |
Total Pages | : 330 |
Release | : 2007-01-01 |
Genre | : Business & Economics |
ISBN | : 9781892904317 |
Author | : Institute of Medicine |
Publisher | : National Academies Press |
Total Pages | : 394 |
Release | : 1997-04-21 |
Genre | : Medical |
ISBN | : 0309175054 |
Managed care has produced dramatic changes in the treatment of mental health and substance abuse problems, known as behavioral health. Managing Managed Care offers an urgently needed assessment of managed care for behavioral health and a framework for purchasing, delivering, and ensuring the quality of behavioral health care. It presents the first objective analysis of the powerful multimillion-dollar accreditation industry and the key accrediting organizations. Managing Managed Care draws evidence-based conclusions about the effectiveness of behavioral health treatments and makes recommendations that address consumer protections, quality improvements, structure and financing, roles of public and private participants, inclusion of special populations, and ethical issues. The volume discusses trends in managed behavioral health care, highlighting the emerging role of the purchaser. The committee explores problems of overlap and fragmentation in the delivery of behavioral health care and discusses the issue of access, a special concern when private systems are restricted and public systems overburdened. Highly applicable to the larger health care system, this volume will be of particular interest to all stakeholders in behavioral healthâ€"federal and state policymakers, public and private purchasers, health care providers and administrators, consumers and consumer advocates, accrediting organizations, and health services researchers.
Author | : Dennis Hursh |
Publisher | : Advantage Media Group |
Total Pages | : 125 |
Release | : 2012-05-15 |
Genre | : Business & Economics |
ISBN | : 1599323133 |
Get Your Career Off on the Right Track! Everything Physicians Need to Know About Employment Contracts COMPENSATION AND BENEFITS *Dangers of productivity compensation *Common incentive compensation formulas - what needs to be included *Benefits to look out for in addition to your compensation *How to determine if you are "disabled," and how the employer should NOTbe able to make this determination *What the employer can, and can't negotiate as far as benefits *Stark law traps, and how to avoid them RESTRICTIVE COVENANTS *What's really important in restrictive covenants, and what isn't worth negotiating over *Minimizing the impact of a restrictive covenant *How you can be released from a restrictive covenant *Negotiation strategies in buy-outs of restrictive covenants CALL COVERAGE *The language you must have DEFINING WHAT IS EXPECTED OF YOU *Patient contact hours expectations *What flexibility an employer will demand THE TERM OF THE AGREEMENT *Issues with hospital and managed care credentialing, and how to work around them *Grounds for termination *"Without cause" termination issues OTHER ISSUES IN AGREEMENTS TO WATCH OUT FOR *Medical record issues *Assignment of location of service *Budgetary weasel language to avoid *Malpractice issues in common provisions MALPRACTICE INSURANCE *The types of coverage, and the significance when you leave *Need for "tail coverage" *How to minimize the devastating cost of "tail coverage" PRIVATE PRACTICE ISSUES *Time to ownership *Concerns with "guaranteed" ownership *Costs of the buy-in *Methodologies for determining the buy-in, and the pros and cons of each *Why a cheap buy-in may not be in your best interest *What provisions are absolutely vital in regard to future ownership
Author | : Leonard J. Marcus |
Publisher | : John Wiley & Sons |
Total Pages | : 514 |
Release | : 2011-06-15 |
Genre | : Medical |
ISBN | : 1118021576 |
Renegotiating Health Care Since the first edition of Renegotiating Health Care was published in 1995, new treatments, technologies, business models, reimbursement methods, and regulations have tangibly transformed the substance of health care negotiation. This thoroughly revised and updated edition of Renegotiating Health Care offers a practical guide to negotiation and conflict resolution in the health care field. It explores why unresolved conflict can hamper any organization's ability to make timely, cost-effective decisions and implement new strategies. The book focuses on the complex interactions between those who deliver, receive, administer, and oversee health care. It defines negotiation techniques and conflict resolution approaches that can improve efficiency, quality of care, and patient safety. Renegotiating Health Care outlines strategies and methods to resolve the myriad thorny issues encompassing the health care enterprise. It should be required reading for students and professionals in health services management, clinicians, leaders, policy makers, and conflict resolution experts working in the health care field. Praise for Renegotiating Health Care "An outstanding book! I learned their principles of meta-leadership while at the CDC and continue to use them at ABC News. This book is a must for anyone in leadership: practical, intuitive, and priceless." Richard E. Besser, MD, chief health and medical editor, ABC News "This book is a must-read to assist today's health professional navigate the ever-changing health care delivery system. Leadership will be the key to success." Pat Ford-Roegner, RN, MSW, FAAN, senior health consultant and former CEO, American Academy of Nursing
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.
Author | : National Academies of Sciences Engineering and Medicine |
Publisher | : |
Total Pages | : |
Release | : 2021-09-30 |
Genre | : |
ISBN | : 9780309685061 |
The decade ahead will test the nation's nearly 4 million nurses in new and complex ways. Nurses live and work at the intersection of health, education, and communities. Nurses work in a wide array of settings and practice at a range of professional levels. They are often the first and most frequent line of contact with people of all backgrounds and experiences seeking care and they represent the largest of the health care professions. A nation cannot fully thrive until everyone - no matter who they are, where they live, or how much money they make - can live their healthiest possible life, and helping people live their healthiest life is and has always been the essential role of nurses. Nurses have a critical role to play in achieving the goal of health equity, but they need robust education, supportive work environments, and autonomy. Accordingly, at the request of the Robert Wood Johnson Foundation, on behalf of the National Academy of Medicine, an ad hoc committee under the auspices of the National Academies of Sciences, Engineering, and Medicine conducted a study aimed at envisioning and charting a path forward for the nursing profession to help reduce inequities in people's ability to achieve their full health potential. The ultimate goal is the achievement of health equity in the United States built on strengthened nursing capacity and expertise. By leveraging these attributes, nursing will help to create and contribute comprehensively to equitable public health and health care systems that are designed to work for everyone. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity explores how nurses can work to reduce health disparities and promote equity, while keeping costs at bay, utilizing technology, and maintaining patient and family-focused care into 2030. This work builds on the foundation set out by The Future of Nursing: Leading Change, Advancing Health (2011) report.