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Optimizing Managed Care Peer Reviews: Turning a "Doc to Doc" Talk Into Better Advocacy for Psychiatric Inpatients

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Optimizing Managed Care Peer Reviews: Turning a "Doc to Doc" Talk Into Better Advocacy for Psychiatric Inpatients

Stuart L Lustig et al. Psychiatr Serv.

Abstract

Clinicians often resent behavioral health managed care peer reviews. However, such reviews need not be onerous. This Open Forum, written by managed care physician reviewers, attempts to help attending psychiatrists, specifically those on inpatient units, achieve more satisfying outcomes for patients by adhering to a few basic principles. Beyond the level-of-care guidelines, attending psychiatrists are advised to focus on immediate acuity, along with specific life events that may have immediate impact on the patient's well-being. A clear diagnosis, relevant treatment plan, salient updates, and strategies for preventing readmission can justify additional treatment time. By contrast, "time-based treatments," dispositional issues, or a patient's lack of acceptance or effective use of treatment are harder to justify.

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