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Thursday, December 15, 2011
Medical Case Management Best Practices
It's no secret that today that health plans and managed care organizations are putting tremendous amounts of money into proactively managing the small percentage of their subscriber populations who consume the majority of their health care resources. Case management utilization review, medical management and disease management are some of the generic terms that are used to describe this process. Independent review organizations act as a key support element in the health care decision making process. They help case managers, utilization review and utilization management nurses improve the health care delivery process so that critical care populations are getting properly attended to with the right treatments, each time, every time. Only independent review organizations can provide for this critical decision support to the managed care organization. Managed care organizations, utilization review and utilization management departments attempt to perform these functions internally without using the appropriate specialists with the latest training in active practice run the risk of not being able to distinguish between necessary and unnecessary treatments. Such decision making is the role of an IRO.
Case managers outsource their medical claims decision making to independent review organizations for a simple reason: They don't have the medical expertise and specialist knowledge in all areas of care management to make effective medical decisions concerning care recommendation for some patients. By involving an independent review organization in their decision making, case managers are able to allocate health care resources quickly and cost effectively to the right people with a high degree of confidence that those resources and those treatments were assigned effectively based upon the standard of care, medical necessity and what's in the plan language. Case managers who use independent review organizations are able to improve their service to their clients and to their patients, assuring effective health care delivery. At the same time, IRO help streamline the decision making process and allow for treatments to happen earlier...sometimes with the added benefit of saving lives or improving patient outcomes. Case managers and utilization review managers who actively use IROs for this purpose often comment on how fast and easy it is to get quick determinations that improve medical outcomes for their active cases.
We've seen many examples of case managers using an IRO to speed up treatments and improve patient safety and reduce the cost over the patient care life cycle. Case managers and utilization review nurses who deploy IROs also find that it's a much faster and easier way to make healthcare decisions compared to waiting on internal or allied doctors. Since independent review organizations are in the business of supporting fast and quality patient health care decisions, they're able to make decisions faster, easier and at a lower cost compared to other processes. This is why case management, utilization review and other types of medical management firms are increasingly turning to IROs as a key resource in their healthcare decision making toolkit.
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Saturday, December 10, 2011
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Basal Cell Skin Cancer
One of the most common forms of cancer in existence is basal cell carcinoma, which is a form of chance.
skin cancer. It can be an extremely destructive and mildly disfiguring form of skin cancer and the risk of developing this particular form of skin cancer increases greatly for individuals who have a history of the disease in their families. The risk of developing it also increases with increased exposure to sunlight, as sunlight causes exposure to damaging UV light. Carcinogenic chemical exposure such as exposure to arsenic also increases the
Treatment options for Basal cell skin cancer include surgery, mohs surgery, X-ray, cryosurgery, topical chemotherapy and photodynamic therapy. It is very rarely a life threatening form of cancer, but if you do not treat it in time it can become disfiguring. Basal cell skin cancer can also cause bleeding, and can produce destruction on a local level. Local destruction that it can cause includes eye, nose, ear and lip damage, though this damage very rarely spreads further than the origin point of the tumor. However, long standing tumors that are not treated may be able to metastasize into lymph nodes and other surrounding areas, which can cause significant internal damage to bone and nearby tissues in the area where the tumor is growing.
There are numerous different forms of Basal cell skin cancer that are recognized, including Nodular Basal, Cystic Basal, Pigmented Basal, Superficial Basal and finally Sclerosing or Cicatrizing Basal. Nodular forms include flesh colored papules that are known as rodent ulcers when they ulcerate. Cystic forms are rarer and tend to be harder to distinguish in comparison to nodular skin cancers. Pigmented forms are often confused with melanoma cancers. Sclerosis forms present scar like lesions, and superficial forms present with red scaling patches.
Two thirds of all Basal cell skin cancer instances occur on areas of the body that are regularly exposed to the sun. One third of all instances of it on the other hand exist on areas of the body that are not regularly exposed to sunlight, and this fact emphasizes the idea that genetics may also cause it in some patients even if they are not regularly exposing their bodies to the harmful UV light provided by the sun. It tends to present as a firm nodule which clearly grows within the skin that exists above and below it. Basal cell skin cancer does not normally do much growing on the surface of the skin. The colors associated with it vary from normal skin color to black or dark brown, though there is always a pearly or translucent quality to the skin which is a telltale sign that a tumor is forming.
Basal cell skin cancer is not normally a deadly form of skin cancer, though it is still vital that the cancer be treated early to prevent it from becoming disfiguring. When it metastasizes, it can cause quite a bit of damage both above and below the skin, so that even after the cancer is treated, there will still be something left behind even once the it is gone.
Wednesday, December 7, 2011
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What is a Cosmetic Physician?
In Australia Cosmetic Physician is a title commonly used to describe a Medical Practitioner that provides one or more non-surgical medical procedures designed to augment or enhance their patient's appearance. Procedures performed include botox, dermal fillers, chemical peels, laser and IPL therapy, cosmetic mole removal, acne treatments, leg and facial vein treatments, microdermabrasion and photodynamic therapy.
It is important to realise that the the title Cosmetic Physician is not a recognised specialist qualification. In Australia no exam or post-graduate study is required to use this title. In fact, any registered Medical Practitioner could refer to himself as a Cosmetic Physician. This is potentially somewhat confusing as the title Physician generally refers to a recognised specialist with post-graduate training and qualifications. It is for this reason that I personally use the term Cosmetic Medicine Doctor.
In Australia there is no government recognised post-graduate Cosmetic Medicine or Cosmetic Surgery qualification. There is no officially recognised training or accreditation in any of the procedures. Training generally is provided by drug companies that produce the products that Cosmetic Doctors use. This is not to say that training is inadequate. In fact, my experience has been that the training and ongoing education provided by these companies is excellent.
There are two groups in Australia that represent doctors paractising non-surgical cosmetic procedures. These are the Australasian Society of Cosmetic Medicine and the Cosmetic Physicians Society of Australasia. No exam needs to be passed to become a Member of either of these Societies. Both these Societies provide educational events and seminars as well as offering more advanced education such as Diplomas and Fellowships. Whilst I am a supporter of ongoing education it is important to realise that none of these qualifications are recognised by the Australian Government as conferring specialist status.
It could be argued that Cosmetic Medicine is a mixture of consumerism and Medical Practice. Sometimes dubious marketing techniques are employed that may exaggerate the qualifications of the Practitioner performing the procedure. As professionals, Medical Practitioners should put the interest of their patients above their own personal interests. Trust and honesty is an integral part of this. Always be prepared to ask a Medical Practitioner what there titles and qualifications really mean.