Analyzing the concept of managed care in therapists work with patients

The chiropractor may treat multiple neuromusculoskeletal conditions during a single visit. Chiropractors use broadly accepted diagnostic procedures to assess diseases and adverse health conditions. The primary mode of chiropractic treatment is manipulation or adjustment. Chiropractic manipulation is the application of a controlled force to re-establish normal articular function.

Analyzing the concept of managed care in therapists work with patients

Types[ edit ] There are several types of network-based managed care programs. They range from more restrictive to less restrictive: As defined in the act, a federally-qualified HMO would, in exchange for a subscriber fee premiumallow members access to a panel of employed physicians or a network of doctors and facilities including hospitals.

In return, the HMO received mandated market access and could receive federal development funds. They are licensed at the state level, under a license that is known as a certificate of authority COArather than under an insurance license.

In practice, an HMO is a coordinated delivery system that combines both the financing and the delivery of health care for enrollees. In the design of the plan, each member is assigned a "gatekeeper", a primary care physician PCP responsible for the overall care of members assigned.

Specialty services require a specific referral from the PCP to the specialist. Non-emergency hospital admissions also require specific pre-authorization by the PCP. Typically, services are not covered if performed by a provider not an employee of or specifically approved by the HMO unless it defines the situation to be an emergency.

Financial sanctions for use of emergency facilities in non-emergency situations were once an issue, but prudent layperson language now applies to all emergency-service utilization, and penalties are rare.

Managed care concepts and rules for reimbursement

Since the s, under the ERISA Act passed in Congress in and its preemptive effect on state common law tort lawsuits that "relate to" Employee Benefit Plans, HMOs administering benefits through private employer health plans have been protected by federal law from malpractice litigationon the grounds that the decisions regarding patient care are administrative rather than medical in nature.

Independent practice association IPA [ edit ] Main article: Most often, the physicians are paid on a basis of capitationwhich in this context means a set amount for each enrolled person assigned to that physician or group of physicians, whether or not that person seeks care.

The contract is not usually exclusive so individual doctors or the group may sign contracts with multiple HMOs. Physicians who participate in IPAs usually also serve fee-for-service patients not associated with managed care.

IPAs usually have a governing board to determine the best forms of practices. Preferred provider organization PPO [ edit ] Main article: Preferred provider organization Rather than contract with the various insurers and third party administrators, providers may contract with preferred provider organizations.

A membership allows a substantial discount below their regularly charged rates from the designated professionals partnered with the organization. Preferred provider organizations themselves earn money by charging an access fee to the insurance company for the use of their network unlike the usual insurance with premiums and corresponding payments paid fully or partially by the insurance provider to the medical doctor.

In terms of using such a plan, unlike an HMO plan, which has a copayment cost share feature a nominal payment generally paid at the time of servicea PPO generally does not have a copayment but offers a deductible and a coinsurance feature.

The deductible must be paid in full before any benefits are provided. After the deductible is met, the coinsurance benefits apply. Charges above the allowed amount are not payable by the patient or insurer but written off as a discount by the physician.

Because the patient is picking up a substantial portion of the "first dollars" of coverage, PPO are the least expensive types of coverage. Point of service plan A POS plan uses some of the features of each of the above plans.

Analyzing the concept of managed care in therapists work with patients

Members of a POS plan do not make a choice about which system to use until the service is being used. In terms of using such a plan, a POS plan has levels of progressively higher patient financial participation, as the patient moves away from the more managed features of the plan.

For example, if patients stay in a network of providers and seeks a referral to use a specialist, they may have a copayment only. However, if they use an out of network provider but do not seek a referral, they will pay more.

POS plans are becoming more popular because they offer more flexibility and freedom of choice than standard HMOs.

Policies may vary from low cost to all-inclusive to meet different demands of customers, depending on needs, preferences and budget.


Fee-for-service is a traditional kind of health care policy: Such plans offer a wide choice of doctors and hospitals.The Home of the 4 Hour Investor Grade Business Plan.

Faster investor quality documentation using HyperQuestions. vocabulary from chapter 3 health care settings Learn with flashcards, games, and more — for free. Search. Create. Hospitals that provide health care services to patients who have serious, sudden, or acute illnesses or injuries and/or who need surgeries.

Managed care contracts are negotiated by hospital(s) and physician groups. concept analysis is to establish clarification of pro- The movement to managed care with hos-pital downsizing, cost containment, and the use of from physicians, patients, and families for care coordination and communication, whether in person or through enhanced technology.

More than 4, ebooks and many book collections, including archive collections of critical historical material, as well as publisher and topical collections. A Comprehensive Review of a 21st-Century Health Care Profession.

i | American Physical Therapy Association Physical therapists are health care profes-sionals who maintain, restore, and improve movement, activity, and health enabling and management of patients within a specialty. Health care or healthcare is the maintenance or improvement of health via the prevention, diagnosis, and treatment of disease, illness, injury, and other physical and mental impairments in human beings.

Healthcare is delivered by health professionals (providers or practitioners) in allied health fields. Physicians and physician associates are a part of these health professionals.

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