AllMed Healthcare Management Blog: 03/09/06
Thursday, March 09, 2006
Large Scale Medical Chart Review Study
http://buffalo.bizjournals.com/
The conditions -- asthma, diabetes, congestive heart failure, coronary artery disease and depression -- involve the largest portion of the doctors' caseload and utilize the most medical resources, said Dr. Cary Vastola, medical director of the Catholic Independent Practice Association, who developed the program with other doctors.
"By focusing our attention on these major health categories, we hope to see a measurable impact on the care and treatment of patients within our system, as well as better management of valuable healthcare resources," he said.
More than 20,000 patients will be involved initially, and will be representative of each of the three major health insurers.
posted by Dr. Skip
Utilization Review Causing Problems For Medicaid Patients
http://pn.psychiatryonline.org
Clinically inappropriate utilization review (UR) requirements by prescription drug plans (PDPs) appear to be the most pervasive—but by no means the only—complaint. In some cases, it appears that UR requirements have been backed up by CMS in defiance of the agency's stated transition policies requiring continuity of medications for people moving from Medicaid into the new program.
Muszynski described the case of one clinician seeking prior authorization to prescribe Zyprexa for a patient previously stabilized on that drug. The clinician was told by a physician reviewer to treat the patient with Clozaril—despite the potential problems associated with that drug and the requirements for regular blood testing.
"In some cases it appears that CMS is just not serious about its own transition policies," Muszynski said. "Another serious concern we are having is that the exceptions and appeals process is one sided and in disarray."
posted by Dr. Skip
Hospital Peer Review Court Decision In Tennessee
The Tennessee Court of Appeals has ruled that Dr. Alexander Stratienko has a right to examine credentialing papers of Dr. Van Stephen Monroe.
The ruling overturns a decision by Circuit Court Judge Sam Payne, who said the documents were confidential and not available for inspection.
Erlanger Medical Center suspended Dr. Stratienko from practice at the hospital after he was involved in a physical altercation with Dr. Monroe in a cath lab.
Dr. Stratienko filed suit and obtained a restraining order blocking the suspension from going into effect.
The case has been on hold while an appeal was made on the issue of whether the credentialing papers of Dr. Monroe could be inspected.
posted by Dr. Skip
