Practice Guidelines, Managed Care, and Utilization Review
"While you were Wheezing"
As a physician your first responsibility is always to your patient. If
you, or your team is not convinced that Janie will do well at home, then act
upon that conviction. However, it is possible to observe and treat Janie
without creating undue financial burdens on her family, the hospital, or the
insurance carrier. The "23-hour observation" was designed to meet that
need.
Janie can be placed in a hospital bed for up to 23 hours without
incurring full admission charges, and the attending physician and team can
determine over the next 23 hours if Janie is stable enough to return home.
You could use this time to provide Janie's grandmother with some basic
education; and if a home nebulizer is needed, the hospital staff can
contact the insurance carrier for the name of their vendor that provides durable medical
equipment.
Of course, his obligation is to the patient.
Only if instructed to do so by the PCP.
Only Janie's PCP can refer to a specialist