Utilization Review on Physician Time With Patients
An ever-present feature in the quest to limit health care costs, utilization reviews have become a cost management necessity for health care providers. The idea is to effectively manage the time physicians spend with each patient in order to maximize revenues.During a utilization review of the time physicians spend with patients, all patients are equally monitored to determine over-utilization of services, under-utilization and inefficient uses, along with the scheduling of medical resources. To conduct a proper utilization review of the physician's time with patients and patient processing, several areas are covered to assure that patient care guidelines are met. These include the admission process, support services, quality of care and discharge procedures.
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Admissions Review
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During a utilization review of a physician's time with patients, all admissions during a specific set period are reviewed. This review can include how patients are admitted, the efficiency of the admission process and patient wait times to see the physician.
Support Services
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A utilization review includes a look at the physician's supporting medical personnel and services. This includes the time spent with patients, and procedures conducted by nurses, lab technicians and other health care personnel before the patient sees the physician.
Quality-of-Care Review
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Monitoring the quality of care a patient receives and the performance of medical staff during the visit to the physician is also part of a utilization review. The time spent with the physician is also monitored and patient satisfaction surveys may be included. At the end of a utilization review, a report called a Performance Improvement Plan recommending quality improvement activities is generated.
Discharge
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An important factor in the care of patients is the time physicians spend on followups. During utilization reviews, the processes used to discharge patients and their followup care is examined. Prescription and the medications, additional health education programs and appointment setting for return visits or testing are all scrutinized.
Utilization Review Guidelines
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Utilization reviews are conducted by impartial third parties often hired by the physicians. The guidelines to establish quality medical care for such utilization reviews have been developed by companies such as Milliman Care Guidelines. They are used the medical industry's standard patient process methodologies to create care guideline by which to measure medical performance. Once performance measurements have been made, they are then reviewed by doctors and nurses for accuracy.
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