Patients admitted to hospitals today often require multiple medical experts to meet their needs. Having a roster of medical experts vastly improves the care the patient receives. But the division of labor presents a number of problems.
A concurrent review evaluates the current level of care that a patient is receiving and determines if any changes should be made to their care.
In this article, we will look at the healthcare industry in general. We will see how the issues of finances, adequate patient care, and future healthcare plans all fit together. We will particularly see how the concurrent review process fits into the overall picture.
A Closer Look at the Concurrent Review
So what is a concurrent review? And why is it done?
This takes place during the time the patient is undergoing care in a facility. This may be a hospital, or it could take place in a specialized place of care, such as a physical rehabilitation center.
The goal is to provide oversight of the type of care provided to the patient, whether it is necessary, and if it is being adequately administered. One key role of this process is to prevent the misuse of in-patient services.
Different patients will be under a variety of medical plans. The concurrent review will use sets of criteria to determine the coverage the patient can afford.
The concurrent review process includes most or all of the following:
- Collecting information about the patient’s condition and progress
- Receiving all data and relevant information regarding medical records
- Assessing their medical plan and establishing what cover is available
- Informing the different people involved in the patient’s care of their situation
- Evaluation of ongoing medical necessities of appropriate care
- Looking ahead to the day of discharge and the potential for ongoing care
- Ensuring urgent decisions are timeously made and the practitioner notified within 24 hours
- Identifying possible specialty care programs such as women’s health issues
- Handling requests to extend a course of treatment that needs to continue beyond the approved date
- Informing the patient about the various medical terms used
Where and How Are These Conducted?
These reviews may take place via onsite evaluations or face-to-face consultations with the patients. However, most of the concurrent reviews will be conducted by phone, fax, or online methods.
Busy physicians and professionals, not to mention the concurrent review nurse, are usually far too overworked to keep appointments with one another. In addition to time, it would be an almost impossible task to arrange an appointment for each occasion the review nurse needed information.
Most of the issues can be discussed just as easily via modern methods of communication. In addition, many hospitals today conduct multi-disciplinary rounds.
In this model of care, multiple members of the care team come together at the patient’s bedside to discuss their care and needs. This team should include the concurrent review nurse.
After such a consultation, the caring review nurse should aim to spend a few minutes with the patient, explaining the healthcare terms used. These can be intimidating, if not overwhelming, to the poor patient who has no medical understanding.
Are These Reviews Really Necessary?
For people who have never been in hospital for a prolonged visit, or have never faced expensive and life-saving surgery or treatment, this may be a valid question. But in today’s global situation, especially when faced with the COVD-19 pandemic, there will be very few people who fall into that category.
It is frequently the case where a patient diagnosed with one problem develops another unrelated issue while in the hospital. For example, it is possible that the patient who was admitted with a cardiac problem and is under the care of a cardiac surgeon has a fall. Suddenly, he needs the attention of an orthopedic surgeon and the scheduling of unanticipated surgery.
An unfortunate, but common, event today is the patient who is in the hospital with a simple diagnosis such as varicose veins. He becomes infected by the Coronavirus and possibly ends up in Intensive Care fighting for his life.
In situations like this, it is imperative to have someone overseeing the entire situation who is aware of all the problems. The concurrent review nurse will need to bring together the different disciplines, and arrange for the medical schemes to come on board.
Hospital Utilization Management
This is a process involving the integration of a patient’s medical activities. Management ensures patients receive care that is both appropriate and necessary.
This includes such areas as risk management, quality assurance, and utilization reviews. These together ensure the patient is receiving the best medical care. At the same time, management controls the wise use of the facility’s resources.
Key to this management system is the utilization review, where organizations may determine whether the offered health care is medically essential and will prove profitable for the individual.
Utilization review is an essential part of managing the cost of health care. These tasks are generally conducted by specially trained and experienced nurses who bring a valuable perspective to this field.
There are three types of assessments involved in the utilization review. These are
- Prospective review
- Concurrent review
- Retrospective review
The prospective review conducted prior to the start of treatment, or before hospital admission, establishes the patient’s suitability for the prospective treatment. It also helps to reassure him that the medical team is fully aware of all his health issues
The concurrent review, as its name suggests, is performed concurrently, or during the treatment or hospital stay. It is ongoing, not just a one-off review.
The retrospective review will take place after the treatment or period in the hospital. Its purpose is to confirm the treatment received was appropriate, necessary, and adequate.
What Is a Healthcare Delivery System?
The range of treatments and care available to patients has increased tremendously over recent years. According to The Centers for Disease Control and Prevention (CDC), in America alone, visits to the physician reached 883.7 million in 2018.
This became unsustainable when the COVID-19 pandemic hit the world. Many of the more recent methods of healthcare saw radical changes. A number of them have shown monumental growth as a result of the pandemic.
This has been around for some years, but it is one area that has escalated due to COVID-19. This allows medical personnel and patients to hold video or phone consultations. This is not only a time-saver, it also cuts down on the risk of infection.
This involves an annual fee similar to a retainer. Not only does it allow for better care, but it also offers the patients greater access to other services.
There are several different plans available under managed care, but they all have similar principles. The patients are limited to a particular group of physicians and healthcare providers.
Integrated Delivery System
This is where a group of healthcare providers come together under one body. This provides a cost-effective and efficient way for the patient to receive adequate medical care.
These systems allow the patients the right to make decisions for themselves. They are given an approved budget from which to operate.
Have We Covered All Your Questions?
We hope this article has helped you see the need for all three types of reviews in the care and wellbeing of each patient, and to ensure prudent use of the available facilities.
If you have unanswered questions concerning concurrent review, we would love you to reach out to us and schedule an appointment.