162). The general practitioner makes sure the patient does not unnecessarily see a specialist for their condition by using the referral management system (Kongstvedt, 2016, p. 162). In fact, the managed care organization will even send periodic reports to the general practitioner about referral rates and costs, thus keeping the general practitioner aware of the appropriate amount of capital being spent (Kongstvedt, 2016, p. 162). In essence, referral management keeps the physician from overspending the health management organizations money while at the same time protecting the physician’s money. Consequently, the patient may feel that their health is truly not being taken into consideration. As an example, Priority Health requires the patient to see their general practitioner when wanting to see a specialist for their medical condition, such as knee …show more content…
164). The utilization management nurse will conduct their research and compare them to the medically evidence-based guidelines, which helps to determine if the patient still needs to be in the medical facility (Kongstvedt, 2016, p. 164). Additionally, the managed care organization will send their own utilization management nurse to ensure proper guidelines are being used by the medical (Kongstvedt, 2016, p. 164), consequently saving the medical facility and their organization money. Furthermore, discharge planning is considered part of current utilization management because it aids in the medical facility meeting avoidable readmissions by Medicare patients (Kongstvedt, 2016, p. 165). Therefore, in the end by the facility using concurrent utilization management and discharge planning it allows them to receive possibly more profit. In fact, this can be used while treating the patient for outpatient care, such as physical therapy. The Managed Care Organization will only allow six visits, and then require position to send the medical diagnosis codes and notes to see if the patient still should be seen. Subsequently, the patient sometimes has to be put on hold until the managed care organization approves of continued care. Once again, the stalling of medical care causes