Term Paper Health Care Law
Running head: Legal Risk Management and the Clinical Utilization Review Process 1
Legal Risk Management and the Clinical Utilization Review Process
Celia Gomez
Wayland Baptist University
HLAD 5337 – Vco1 Health Care Law
Dr. Lloyd L. Cannedy, Ph. D.
October 01.2012
Legal Risk Management and the Clinical Utilization Review Process 2
Abstract
Use the text book, case studies and other references to determine the history and process of Legal Risk Management and the Clinical Utilization Review Process. It will identify weaknesses and strong points of the current Clinical Utilization Review Process. It will address Legal Risk Management in the early years and the statistics and growth of Managed Care and the restructuring of Managed Care. It will explore the legislative and regulatory decision including debates surrounding the Legal Risk Management and the Clinical Utilization Review Process. It will explore the purpose of the medical review process and the impacts medical decision making has on patients. Finally it will cover the goals of the medical review process and quality management to end with a conclusion.
Legal Risk Management and the Clinical Utilization Review Process 3
Legal Risk Management and the Clinical Utilization Review Process
An Overview of Risk Management
The Legal Risk Management process is nothing new for the health care industry nor is it a new social or legal ordained program. In fact as early as four thousand years ago the Babylonian Code implemented severe punishment to physicians that caused death or harm to patient through their own malpractice. Law wrote: “should a physician operate on a man with a bronze lancet and cause a man’s death, they shall cut off his fingers”. In the 1970’s began a large upward movement in malpractice suits creating a crisis situation for physicians and the health care industry as whole. As a result of these huge numbers of dollars in law suits the
Legal Risk Management and the Clinical Utilization Review Process
Celia Gomez
Wayland Baptist University
HLAD 5337 – Vco1 Health Care Law
Dr. Lloyd L. Cannedy, Ph. D.
October 01.2012
Legal Risk Management and the Clinical Utilization Review Process 2
Abstract
Use the text book, case studies and other references to determine the history and process of Legal Risk Management and the Clinical Utilization Review Process. It will identify weaknesses and strong points of the current Clinical Utilization Review Process. It will address Legal Risk Management in the early years and the statistics and growth of Managed Care and the restructuring of Managed Care. It will explore the legislative and regulatory decision including debates surrounding the Legal Risk Management and the Clinical Utilization Review Process. It will explore the purpose of the medical review process and the impacts medical decision making has on patients. Finally it will cover the goals of the medical review process and quality management to end with a conclusion.
Legal Risk Management and the Clinical Utilization Review Process 3
Legal Risk Management and the Clinical Utilization Review Process
An Overview of Risk Management
The Legal Risk Management process is nothing new for the health care industry nor is it a new social or legal ordained program. In fact as early as four thousand years ago the Babylonian Code implemented severe punishment to physicians that caused death or harm to patient through their own malpractice. Law wrote: “should a physician operate on a man with a bronze lancet and cause a man’s death, they shall cut off his fingers”. In the 1970’s began a large upward movement in malpractice suits creating a crisis situation for physicians and the health care industry as whole. As a result of these huge numbers of dollars in law suits the