Doctors Who Are Just Plain Bad
A physician/surgeon friend resents utilization review with a burning passion (and he’s not one of the doctors who is just plain bad). He complains that reviewers aren’t as knowledgeable about what he does as a doctor. Of course he is right insofar as the technical points of his clinical practice are concerned.
But reviewers, both physicians and nurses, are very able in applying the facts presented in a medical record to the criteria required by the guy who pays the bill (carrier, employer, Medicare, etc.) They can become so well trained in this that the American Board of Medical Specialties recognizes the American Board of Quality Assurance and Utilization Review, credentialing physicians in the actual specialty of which my friend complains.
The most significant point is that there are doctors who are just plain bad. Otis Webb Brawley, MD in How We Do Harm asks: “Why do they continue to practice without impediment? The answer is simple:because no one is looking over their shoulders, no one files a disciplinary complaint, no tribunal of peers punishes them unless they do something spectacularly awful.”
Bad medicine is very expensive. If you want your plan to excel, make sure your network actively credentials its participating doctors and do aggressive utilization review. My friend won’t like it but it’s the right thing to do.
Call us, We can do better.