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Managing Managed Care II, Second Edition

A Handbook for Mental Health Professionals

Michael Goodman, M.D., Janet Brown, R.N., C.P.H.Q., and Pamela M. Deitz, L.C.S.W.

  • ISBN 978-0-88048-772-6
  • Item #8772

Description

Managing Managed Care II: A Handbook for Mental Health Professionals, Second Edition, provides an easy-to-learn, easy-to-use method for documenting and communicating the necessity, appropriateness, and course of treatment for managed care review. Using the Patient Impairment Profile method, practitioners can convincingly convey a clinical rationale for treatment, efficiently track progress over time, and demonstrate favorable patient outcomes.

Keeping pace with the evolving and expanding presence of managed care, the authors have extensively revised and enlarged the previous edition. New clinical research on the validity and reliability of the impairment terminology has produced a much-improved, clinically valid, and statistically reliable impairment lexicon. Detailed severity rating qualifiers, reference lists of patient objectives, and a useful glossary have been added. All regulations have also been updated.

Managing Managed Care II is reference and valuable resource for mental health practitioners and for the individuals who monitor and review treatment. By providing concise, relevant, and outcome-focused treatment information, practitioners become proactive participants in managed care while adeptly articulating the value and quality of their services.

Contents

Introduction. The public demand for practitioner accountability. The need for a behavior-based common language of treatment. Patient impairments and the diagnosis. Patient impairments and the justification for treatment. Impairment severity and appropriateness of treatment. Treatment goals and patient objectives. Practitioner interventions and the treatment plan. Patient progress and the effectiveness of treatment. Managing the future of managed care. Glossary. Appendix A: Patient impairment definitions. Appendix B: Severity rating qualifiers (critical impairments). Appendix C: Patient objectives reference list (critical impairments). References. Index.

About the Authors

Michael Goodman, M.D., was a clinical psychiatrist in private practice in Beverly Hills and Pasadena, California. Dr. Goodman has 14 years of experience as a physician adviser with the former California Professional Standards Review Organization and its current successor, California Medical Review, Inc.

Janet A. Brown, R.N., C.P.H.Q., is a consultant in quality, utilization, and risk management with psychiatric and medical-surgical, acute and ambulatory health care organizations, all of which are now positioning for managed care. Ms. Brown is the author of The Quality Management Professional’s Study Guide, now in its 10th edition, and serves as an instructor for quality management professionals preparing for the certification exam. She has chaired the National Healthcare Quality Educational Foundation and is the 1995–1996 president of the National Association for Healthcare Quality.

Pamela M. Deitz, L.C.S.W., M.F.C.C., is a psychotherapist in private practice. Ms. Deitz has continued to work in both agency and hospital settings. Her role as developer and clinical director of an adolescent treatment program heightened her awareness of and interest in the impact of managed care on all clinical disciplines providing mental health services.

This one is a particularly good one in terms of internal consistency, clarity, and case study illustrations. The discussions of the linguistic confusion regarding goals, objectives, and treatment plans in both managed care and provider sectors is both amusing and on the mark, and the authors’ reformulations are lucid. Practitioners bewildered by the diversity of questions and standards used by their managed care plans or frustrated at their reimbursement denials will probably find the documentation method and suggested data structures helpful in reducing managed care denials. . . . [I]t represents a practitioner friendly approach to addressing managed care’s oversight questions and makes an important step toward a common language for mental health services accountability.—Contemporary Psychology

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