AHS450_Unit11 - AHS 450 QUALITY MANAGEMENT IN HEALTH CARE...

Info iconThis preview shows pages 1–9. Sign up to view the full content.

View Full Document Right Arrow Icon
AHS 450 QUALITY MANAGEMENT IN HEALTH CARE UNIT 11: MANAGING RESOURCES
Background image of page 1

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Topics Covered in This Lecture ± How health care resources are managed ² Measurement ² Assessment ² Improvement
Background image of page 2
External Requirements ± Medicare Conditions of Participation utilization review requirements ± Joint Commission standards
Background image of page 3

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Written Plans ± Utilization or resource management plan ² Authority and responsibilities ² Accountability and reporting structures ² Role of physician advisors ² Review mechanisms ² How review decisions and appeals are handled
Background image of page 4
Hospital Utilization Management Structure
Background image of page 5

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Physician Involvement ± Health plans have medical director ± Hospitals have physician advisors
Background image of page 6
Criteria-Based Utilization Review Milliman Care Guidelines InterQual Criteria
Background image of page 7

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Patient: Jane Applegate (Female, Age 59) Reason for Hospital Admission: Open Cholecystectomy, elective Day 1 Monday Patient admitted for open cholecystectomy. Surgery done the morning of admission.
Background image of page 8
Image of page 9
This is the end of the preview. Sign up to access the rest of the document.

Page1 / 17

AHS450_Unit11 - AHS 450 QUALITY MANAGEMENT IN HEALTH CARE...

This preview shows document pages 1 - 9. Sign up to view the full document.

View Full Document Right Arrow Icon
Ask a homework question - tutors are online