Medical Doctor Reviews

Health care challenges are ever present and the best way to determine issues that

relate to claims and utilization is to have a qualified third party organization conduct medical doctor reviews of the patient records. The challenges to organization are extreme in that they are continually pressed to provide a very high level of care at a quality standard that is acceptable, and at the same time to engage in cost containment while the staff is subjected to time performance standards, severe time restraints, and organizational deadlines for quality care improvement.

In addition the regulatory requirements change frequently adding to the complexity of managed care. The ever-changing needs for complex medical procedures and treatments further complicate this almost unmanageable process. There is little to none staff time for analysis of the medical records to get a comprehensive overview of what the changing environment of health care needs are, as they could be applied to the organizational standards.

This is why most organizations seek outside, independent medical records reviews that are conducted by trained medical doctors that are not under the same pressures as the those employed by the organization to provide the care at the standards that the organization has determined is required for maintaining their accreditation and for providing a pre-set goal of a standard of care.

Qualified medical doctor reviews achieve a number of positive dynamics and operate on a certain high level of standards, such as independent review is unbiased, expert review is according to know best practices that are not dependent on resource allocation or regional distinctions but are the gold standard of care that every organization should strive for, no matter what their budget constraints happen to be or what regional issues that they must face.

Physicians and staff of any organization are frequently under so much performance pressure that they are not allowed and do not have the time to stay alert to all the current best practices and that is why a medical doctor review by experts in the field can be informative, educational, and the seed of necessary changes that need to be made in any organizations policies and procedures to improve the quality of care.

by: Talking Heads

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