Managed Care

  Managed Care Resources for Spine Practices  

10 Methods for Effectively Dealing with Managed Care Situations 

1. Position yourself as an advocate for the patient.
   -Empower your patients--educate them on managed care issues.
   -Keep in mind financial vs. quality care. 
   -Advocate for effective patient care and outcomes.
2. When requesting an exception to the guidelines insist on speaking with a physician reviewer.
3. Identify a common goal. Example: the quality care of the patient is most IMPORTANT.
4. Be prepared. Have available: 
   -Background on the patient. 
   -Examples of the cost consciousness of your efforts.
5. Treat the physician reviewer with respectful resolve. 
   Be friendly and professional. 
   -Do not fight it -- work with it. 
   -Do not assume you know ALL the answers.
6. Focus on the objective findings, not the subjective ones and note their impact on function.
7. Be prepared to identify alternatives on how to handle the patient's care. Send records, make a conference call.
8. Keep a running abstract on your patient showing treatments and results.
9. Your individual time is needed -- do not send someone who is not equipped to fight this battle for you.
10. If the opportunity presents itself, become involved in developing treatment guidelines for managed care.

These guidelines were developed by the NASS Committee on Managed Care.

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