Assignment: Practicing Medicine Paper
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Assignment: Practicing Medicine Paper
1. Does UR constitute “practicing medicine” and if so should UR be limited to only those medical professionals licensed to practice medicine Utilization Review does not necessarily constitute “practicing medicine” per se, but it absolutely does require an extensive amount of medical knowledge to run a Utilization Review program. Often times, it is the practice of medicine that is being reviewed. For one to claim that a provider is over or under utilizing certain services, one must have medical reasoning to back it up. Such claims are not only very difficult for a non-physician to back up in terms of credibility, but especially difficult to create in the first place. It is a provider, often a senior physician, who can best understand the practice through empirical knowledge, and therefore the cost containment of medical practices without jeopardizing the quality of healthcare.
2. Discuss who you think should head the utilization review program and justify your answer As mentioned in the “background” section of this module, UR was originally created to contain the cost of healthcare (TUI, 2017). If that were still the case today, I would say either a senior physician or a senior healthcare administrator could head the UR program. However, in recent years, UR programs have morphed into both a cost containment program, as well as a quality of healthcare program. Especially as the federal government financially supports programs such as ACOs, PCHM, and payment methods such as value-based and bundled payments (Adirim, 2016). All of which require quality measures to be reported and affect the reimbursements of the organization thereof.
Assignment: Practicing Medicine
Assignment: Practicing Medicine
Considering quality of healthcare is now at the forefront, I believe a senior physician is the most appropriate person for the job!
You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.
Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.
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The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.
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