Healthcare spending is on the rise. The federal government has begun several initiatives to control costs, increase efficiency, and increase quality. Revisiting one of the ACA, Medical Loss Ratio.
Medical directors face novel legal risks for professional liability, regulatory compliance, licensure board complaints, and careless communication habits. A more thoughtful understanding of the distinct obligations and potential medical director legal risks may help medical directors and their employers avoid unnecessary stress and minimize the chances of legal entanglements.
Imaging faster reimbursement cycles must include reviewing processes on both sides of the payer/provider relationship. Too many decades of combative mudslinging makes a comprehensive review and retooling difficult. New organizational structures, like ACOs, begin breaking down barriers allowing for collaborative improvements.
Health reform puts healthcare organizations at more financial risk than ever for care costs and quality, both inside and outside their workplace. But it doesn't change the fundamental fact that physicians, even employed physicians, remain the final arbiters of what care actually is provided. CMO responsibilities evolve with need and business acumen grows as a vital need.
The Medical Director role takes on a dramatic evolutionary shift in responsibility and scope due to healthcare reform (and re-reform) and an industry which is now focused on efficiently driven quality care.
Level of Care Guidelines are usually derived from generally accepted standards of behavioral health practice. These standards include guidelines and consensus statements produced by professional specialty societies, as well as guidance from governmental sources such as CMS’ National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs).