Sunday, November 17, 2019

Managed Care Essay Example | Topics and Well Written Essays - 500 words - 1

Managed Care - Essay Example If the outcome is a positive one, then resources should be devoted to treating that diagnosis based on the outcome. Arnold Birenbaum explains this in terms the lay person can easily understand, but it can be summed up this way: the outcome dictates, justifies, the expense of the intervention (Birenbaum, 13-14). This is a process that actually allocates a financial value to the DRG, and, today, insurance companies will not exceed the value in reimbursement that is dictated by the DRG. Further, the care of each patient is assigned to a case manager to oversee the rendering of the care, and to ensure that neither the services nor the days allocated to the intervention exceed the allocated DRG. Patient care has essentially been wrested away from the physician, and the physician is no longer alone in deciding the best course of care and treatment for his/her patient’s condition. Managed care has adversely impacted the doctor/patient relationship, because a patient’s care is no longer a response to the patient’s condition decided upon and agreed upon between the patient and the physician. Also, the definition of managed care suggests that a physician is no longer free to allocate resources and services to a patient’s care in order to maintain and improve the quality of life regardless of the projected or predicted outcome. Rebecca M. Bolen and J. Camille Hall (2007) say that the arm of managed care which put a stronghold on physician’s decision making processes on behalf of their patients has now reached other healthcare disciplines; nursing, social work, and psychiatric services and clinical providers (Bolen and Hall, 463). It is referred to as evidence based practice (EBP). If the evidence, as with the DRGs, points to a positive outcome, then the intervention shall reflect the extent of the outcome; otherwise, there is no approved intervention for negative outcomes based on the evidence (Bolen and Hall, 463). Physicians long

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