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Confessions of a concurrent reviewer
1Department of Psychiatry, University of Texas, Southwestern Medical Center at Dallas 75235, USA.
Psychiatric Services (Washington, D.C.)
|January 1, 1996
Summary
Physician reviewers in managed care enhance accountability in psychiatric practice by clarifying treatment standards and managing adversarial relationships. This role can positively or negatively impact patient care and clinical practice.
Area of Science:
- Psychiatry
- Healthcare Management
- Medical Ethics
Background:
- Physician reviewers play a crucial role in managed care.
- Understanding the complexities of this role is essential for effective psychiatric practice.
- Managed care oversight impacts clinical decision-making and accountability.
Purpose of the Study:
- To explore the experiences and challenges faced by a physician reviewer in managed care.
- To highlight the impact of physician review on psychiatric practice and accountability.
- To provide insights into the interactions between reviewers and attending psychiatrists.
Main Methods:
- Qualitative analysis of two years of experience as a physician reviewer for managed care organizations.
- Case examples illustrating key issues and learning experiences.
- Development of a typology for reviewer-psychiatrist interactions.
Main Results:
- Reviewer training and experience increased awareness of the need for accountability in psychiatric practice.
- Key issues included crisis intervention, defining intensive vs. inpatient care, social admissions, discharge planning, and managing adversarial relationships.
- A typology of reviewer-psychiatrist interactions was developed.
Conclusions:
- Physician review in managed care necessitates clarification of treatment standards and effective communication.
- The reviewer role can foster greater accountability but also presents challenges in professional relationships.
- Review processes can have both beneficial and detrimental effects on psychiatric practice.