Process of Concurrent Utilization Review Essay Example for Free

Process of Concurrent Utilization Review Essay In Health Industry, the process of Concurrent Utilization Review has its own importance for the management of health care industry enabling them to control the Length of Stay(LOS) of patients in the hospitals and their use of ancillary services. This process is vastly used in the system and procedures adopted in the hospital care because of the high cost involved in it, though its application can be put practically in use in other medical settings as well. The Concurrent utilization review implies that players providing medical care facilites need to provide all the information necessary in the health care to their payers who in turn determine its usability in the current settings of the hospital, before alloting the certificate for reimbursement to the plan. The process has a direct impact on the hospitalized American patients who are covered under the health insurance schemes. Insurance companies are payers in the field. They either conduct their own reviews or hire a review company to access the level and need of the patient and hospitals are providers who hire its own staff for this purpose. Staff members provide all the clinical information required to be authorized for reimbursement, but the first level of review is conducted by a registered nurse who is highly qualified to cover patients of a particular area. Nurses provide all the details of patients to payers including the severity of illness, the duration of patients kept on observation and assessment by registered nurses. If patients condition is considered as stable and he or she does not require this assessment then they are kept for observations in settings considered cheap. Second part of the information is the summary of the plan discussed and formulated for the care of patient. Then the role of payers comes in who evaluate this information to see the usability, the importance of this plan for patients and furthermore if this plan has followed the requirements of the terms of the contract signed with the provider. After this process of evaluation only, the plan is certified for reimbursement. Mary Ellen Murry went deep further to analyse the extent to look into the practical effectiveness of this process since its application in the Health Industry. There are various aspects to it that Mary Ellen tried to make the payers in the Health Industry to focus on. Reviews are undertaken to make sure that inpatients and outpatients are getting proper care in timely manner and the treatment and health care is cost-effective.    It also involves assessment of patients’ health to assure them proper and effective after- care. It is also used to assess if the resources are being used effectively and to differentiate any superfluous or pertinent activity. This is the most crucial strength of this review. Another point worth mentioning is the point when the planned care is refused certification for reimbursement. In this case both the payers and providers are held responsible for the outcome. In a benchmark case between Wickline v. State of California the court gave the statement that: â€Å"a patient who is harmed when care which should have been provided is not provided should recover from all responsible for deprivation of care, including, when appropriate, a health care payer Third party payers of health care services can be legally held accountable when medically inappropriate decisions result from defects in designs or implementation of cost containment mechanisms A physician who complies without protest when his medical judgment dictates otherwise, can not avoid his ultimate responsibility for his patients care. (Murray 2001) This ruling is a reminder to physicians for their duty and obligation in the decision making. Ross too stated in 1996 that according to law, the insurance carriers are bound by the duty to conduct investigation before deciding on refusal of payment. This is another strong point of the importance of conducting reviews according to the existing medical standards.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The review is most applicable in all the cases and the immediate feedback provides health authorities uptodate information on the necessary steps needed, shortcomings arising out of the current care and help insurance givers to update themselves with the requisite reimbursements. The visualisation techniqe of stacked bar gives details on the daily plan activities. (Dr. Tan 1998) Concurrent Utilizaton Review is also not without its limitation. Looking at the large number of providers and players involved in this program all over the country, the process needs requisitive number of registered nurses. In case of the shortage,the investment required for their appointments can become burdensome and the studies conducted on some of the institutions also revealed the fact that some of the staff members conducting reviews are not registered nurses, though they are in possession of baccalaureate degree. The hospital authorities claim that these nurses and staff alloted for review are trained in their requisite field and hospitals can substitute assisting staff instead of registered nurses to perform the Concurrent Utilization Review process increasing the availability of professional nurses. Controversy is going on the extent to which the economic criteria should be taken in the matter of providing quality care to the patients. Hereby most physicians feel that without compromising on the quality of the measures adopted for the health care, cost can be minimized.   The validity of these reviews is also questioned. It is doubted if these reviews have been based on evidence from high-quality studies, definitive randomized trials or meta-analyses of multiple trials, which are the key indicators for the trials. If reviews are found not based on the solid evidence then those developing audit criteria should take expert opinion. Reliance on opinion and inference weakens not only the validity of the criteria for a process-of-care audit, but also the validity of any conclusions derived from applying the criteria. This can be done by having a multi-specialty panel rating on hundreds of different case scenarios depending on the intensity of risks and the panelists make ratings on the basis of literature review and own judgments. Authors involved in Utilization Review process consider cost saving factor as the important criteria in preparing plans for health care. The most effective study conducted I found was by the Wickizer, Wheeler, and Feldstein (1989) who came to the conclusion that these concurrent review programs have led to the â€Å"Decline of hospital admissions by 13%, inpatient days by 11%, expenditures on routine inpatient services by 7%, expenditures on ancillary services by 9%, and total medical expenditures by 7%.† (Murry 2001) They make the use of insurance claims data to determine if costs incurred by the hospitals are matching with the increase in expenditures being incured on the outpatients. Results show that reviews conform to the higher hospital expenditures instead of higher physician office or outpatient diagnostic expenditures. Another study by Wickizer which was conducted in 1991 found that utilization review was showing reduced expenditures of approximately 15% in the surgical cases and slight reductions of expenditures in the mental health and medical areas. These reductions of expenditures showed there have been denials of certification for reimbursement. They came to conclusion that a UR program restricting access to psychiatric care increases the chance of readmission within 60 days. Another telephonic survey   conducted by Remler et al. in 1997 of 2,003, physicians in the United States show the denial rates to be less than 6 per cent in the first rate and 3 per cent subsequently. Both these survyes indicate that the reviews can enable payers to reduce their costs on health care.   The policy implication could be at the cost of reducing the effectiveness of the health care finally being provided to outgoing patients, but to overcome this, hospitals have comprehensive case management programs, to ensure the proper coordination of the care related services including proper utilization of resources. These case managers make a point that every patient has both hospital care plan, including a discharge plan, and along with that a team of clinical social work and case manager associates, are responsible for   the conduct of the UR function. And if this process keeps on going in all the hospitals and other clinics and health care institutes in letter and spirit, then the anticipated denial rates will be reduced to a considerable degree. REFERENCE LIST Murray M.E. 2001. Outcomes of Concurrent Utilization Review. Nursing Economics , 19 (1). 7 pg. Tan J. K.H. 1998. Health Decision Support Systems. Maryland: Aspen Publishers.

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Customs and traditions differ from one part of Nepal to another. A conglomeration lies in capital city Kathmandu where cultures are blending to form a national identity. Kathmandu Valley has served as the country’s cultural metropolis since the unification of Nepal in the 18th Century.A prominent factor in a Nepali’s everyday life is religion. Adding color to the lives of Nepalis are festivals the year round which they celebrate with much pomp and joy. Food plays an important role in the celebration of these festivals. Religion: Nepal was declared a secular country by the Parliament on May 18, 2006. Religions practiced in Nepal are: Hinduism, Buddhism, Islam, Christianity, Jainism, Sikhism, Bon, ancestor worship and animism. The majority of Nepalis are either Hindus or Buddhism. The two have co-existed in harmony through centuries. Buddha is widely worshipped by both Buddhists and Hindus of Nepal. The five Dhyani Buddhas; Vairochana, Akshobhaya, Rathasambhava, Amitabha and Amoghasiddhi, represent the five basic elements: earth, fire, water, air and ether. Buddhist philosophy conceive...

The Art of Ballet

The art of ballet started out as a fun dance for the wealthy and throughout history, has evolved into an elegant, world wide form of structured expression. From its beginnings in European cultures to its now widespread and diverse variations, ballet shows no signs of slowing down in popularity any time soon. Early ballet was influenced by the social dancing of its day, ballroom dancing. This art was born when the ancient Greek and Roman renaissance of the fifteenth and sixteenth centuries took place, reviving an interest in all things human and the arts.The word â€Å"ballet† derives from the Italian word â€Å"balla,† meaning dance. In the Italian city-states of the fifteenth century, many â€Å"balli† meaning â€Å"dances† were held. The ballis involved specific steps that our generation would classify as ballroom steps. Ballet got much recognition when Louis XIV ascended to the throne of France. He came from an arts school where he studied the arts of f encing, music, and dance. His passion for dance was very serious. So serious in fact, that he established the Academic Royale de Danse in 1661, employing 13 ballet instructors.Another well –known founder of ballet is Jean-Georgeos Noverre, also known as the â€Å"Shakespeare of Dance†. He argued for a new, more expressive form of ballet. He created ballet d’action, meaning ballet with out instruments. The Romantic Period played a very important role in the development of women in ballet. This period began in the early eighteen-hundreds. The milestones accomplished within this time period included large female background dancers to accompany the prima ballerina, the lightening of female costumes, and women dancing en pointe.Dancing en pointe, turn out, and the basic five ballet positions exemplify ballet, and are now standard for all ballerinas. The next step on the road to modern ballet is the formation of classical ballet. While the first production of the ball et known as La Sylphide took place in Paris and most famous ballerinas of the day were still coming from Italy, the second half of the nineteenth century saw the axis of the ballet world shift from Western Europe to Russia. However, a Frenchman was responsible for this shift.Marius Petita created five of ballet’s greatest classics in the late nineteenth century: Don Quixote, La Bayadere, The Sleeping Beauty, Swan Lake, and The Nutcracker, as well as restaging Giselle and La Coppelia. All of these classics share common similarities marking them as the trademarks of what is now regarded as the classical repertoire. They generally begin with group dances and evolved into complex stories between two or three main characters. The grand pas de deux, meaning big step for two, commonly begins with an adagio (slow, lyrical dance) between a male and a female dancer.The dance includes high extensions of the woman’s legs, multiple pirouettes, and big leaps forming a long straight line with the female’s legs in the air. Following the adagio is the allegro. This portion is merely a solo showcase of the male dancer’s ability and strength across the stage. An allegro for a ballerina features softer, yet intricate footwork and pirouettes. Finally, we have the coda, or finale, which reunites the dancers in an exuberant flourish. During that time period, three schools of classical ballet emerged.The French school is the oldest of the three. Known for its grace and elegance rather than its technical virtuosity, the French school was nevertheless held in high regard. The Italian school was known for its dexterity, difficulty of its steps, high leaps, and multiple turns. Lastly there was the Russian school. The Russian school was basically a hybrid of the prior schools. This school was held in high esteem due to its combination of serene elegance, breathtaking choreography, and the most complete and well-developed technique in all of ballet.The Russian b allet school slowly led the movement of ballet throughout the world and is responsible for how far ballet has grown. While Petipa’s traditional romantic style still held sway over Europe and Russia, Isadora Duncan, a freethinking American brought a completely new aesthetic to the stage. She believed in a more â€Å"anit-ballet† view of dance. She believed ballet was elitist and superficial. Duncan started a form of dance that was quite the opposite of what ballet was known for. This style of dance would be natural, free, and unbounded by rules.Duncan took her dancing on the road, touring through Europe and Russia alone, barefoot, and dressed in long tunics. The traditional aspect of her performance was the music she danced to, which was mostly Mendelssohn, Beethoven, and Chopin. She had many enemies, but with every enemy she gained, there were hundreds who thought her dramatic expression was lively and wquite enjoyable. Through the next few years, modern dancers began to fuse ballet with their own expressive movements. Also, ballet choreographers began incorporating modern techniques into their dances.As time moved forward, so did the swift evolution of ballet. Cultures took the basics and made it their own and by the late 1970’s , many classical ballet companies started incorporating modern steps into its repertoire and hiring modern choreographers to construct distinctive works on its own dancers. It is evident that as the world changes and its people continue to gain knowledge about their surroundings, the art of ballet will continue to spark interest and develop creativity in many people aspiring to gain the technique of the craft.

Abington School District v. Schempp Murray v. Curlett

Do public school officials have the authority to pick a particular version or translation of the Christian Bible and have children read passages from that Bible every day? There was a time when such practices occurred in many school districts across the country but they were challenged alongside school prayers and ultimately the Supreme Court found the tradition to be unconstitutional. Schools cannot pick Bibles to be read or recommend that Bibles be read. Fast Facts: Abington School District v. Schempp Case Argued: February 27—28, 1963Decision Issued:  June 17, 1963Petitioner: School District of Abington Township, PennsylvaniaRespondent:   Edward Lewis SchemppKey Question: Did a Pennsylvania law requiring public school students to participate in religious exercises violate their religious rights as protected by the First and Fourteenth Amendments?Majority Decision: Justices Warren, Black, Douglas, Clark, Harlan, White, Brennan, and GoldbergDissenting: Justice StewartRuling: Under the First Amendment’s Establishment Clause, public schools cannot sponsor Bible readings or recitations of the Lord’s Prayer.  Laws requiring participation in religious exercises directly violated the First Amendment.   Background Information Both Abington School District v. Schempp and Murray v. Curlett dealt with state-approved reading of Bible passages before classes in public schools. Schempp was brought to trial by a religious family who had contacted the ACLU. The Schempps challenged a Pennsylvania law which stated that: ...at least ten verses from the Holy Bible shall be read, without comment, at the opening of each public school day. Any child shall be excused from such Bible reading, or attending such Bible reading, upon written request of his parent or guardian. This was disallowed by a federal district court. Murray was brought to trial by an atheist: Madalyn Murray (later OHair), who was working on behalf of her sons, William and Garth. Murray challenged a Baltimore statute that provided for the reading, without comment, of a chapter of the Holy Bible and/or of the Lords Prayer before the start of classes. This statute was upheld by both a state court and the Maryland Court of Appeals. Court Decision Arguments for both cases were heard on the 27th and 28th of February, 1963. On the 17th of June, 1963, the Court ruled 8-1 against of allowing the reciting of the Bible verses and the Lords Prayer. Justice Clark wrote at length in his majority opinion about the history and importance of religion in America, but his conclusion was that the Constitution forbids any establishment of religion, that prayer is a form of religion, and that hence state-sponsored or mandated Bible reading in public schools cannot be allowed. For the first time, a test was created to evaluate Establishment questions before courts: ...what are the purpose and primary effect of the enactment. If either is the advancement or inhibition of religion then the enactment exceeds the scope of legislative power as circumscribed by the Constitution. That is to say that to withstand the structures of the Establishment Clause there must be a secular legislative purpose and a primary effect that neither advances nor inhibits religion. [emphasis added] Justice Brennan wrote in a concurring opinion that, while legislators argued that they had a secular purpose with their law, their goals could have been achieved with readings from secular document. The law, however, only specified the use of religious literature and prayer. That the Bible readings were to be made without comment demonstrated even further that the legislators knew that they were dealing with specifically religious literature and wanted to avoid sectarian interpretations. A violation of the Free Exercise Clause was also created by the coercive effect of the readings. That this might entail only minor encroachments on the First Amendment, as argued by others, was irrelevant. The comparative study of religion in public schools is not prohibited, for example, but those religious observances were not created with such studies in mind. Significance of the Case This case was essentially a repeat of the Courts earlier Court Decision in Engel v. Vitale, in which the Court identified constitutional violations and struck the legislation. As with Engel, the Court held that the voluntary nature of religious exercises (even allowing parents to exempt their children) did not prevent the statutes from violating the Establishment Clause. There was, of course, an intensely negative public reaction. In May 1964, there were more than 145 proposed constitutional amendments in the House of Representatives which would permit school prayer and effectively reverse both decisions. Representative L. Mendell Rivers accused the Court of legislating - they never adjudicate - with one eye on the Kremlin and the other on the NAACP. Cardinal Spellman claimed that the decision struck ...at the very heart of the Godly tradition in which Americas children have for so long been raised. Although people commonly claim that Murray, who later founded the American Atheists, was the women who got prayer kicked out of public schools (and she was willing to take the credit), it should be clear that even had she never existed, the Schempp case still would have come to the Court and neither case dealt directly with school prayer at all — they were, instead, about Bible readings in public schools.