The Science Journal of the American Association for Respiratory Care

1997 OPEN FORUM Abstracts

Medical Directors and Utilization Management: Challenges and Opportunities

David M. Burns, M.D., Friday, December 5, 1997.

The role of the medical director of respiratory care in ensuring the quality and availability of respiratory care services becomes even more critical in an environment of cost containment and intense competition. The forces driving the need for cost reductions are real, and the opportunities for cost savings in respiratory care are substantial; and these cost savings can be implemented with out compromising the quality of care delivered. Savings are available in staffing, equipment and management; but the largest opportunity is in reduction of the over-utilization of routine respiratory care procedures. Defining and implementing patient driven protocols for delivery, based on a locally developed consensus about what care is necessary, can substantially reduce the costs of care delivery. At the same time, these protocols offer the opportunity to standardize and improve the care delivered, educate physicians and other staff, rapidly and safely introduce new technology, and defend local standards of care against arbitrary decision making by insurers. The medical director can use the need to constrain costs as a tool to motivate changes in physician behavior and can use the development of protocols as an opportunity to take control over the decisions about appropriate utilization. The current crisis in health care delivery places all of us at risk, but the same crisis provides the energy and opportunity for change that can allow dramatic improvement in the care delivery process.

AARC 50th Anniversary, December 6 - 9, 1997, New Orleans, Louisiana.

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