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March 25, 1998

Reengineering Quality in Managed Care

JAMA. 1998;279(12):913. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-12-jbk0325

To the Editor.—As president of the Palm Beach County Medical Society this past year, my concern was to educate people about the quality of care they were not receiving. However, after reading the Commentary on managed care and quality by Dr Brook,1 I would like to point out that either the managed care in southeast Florida is a different animal from what Brook has in California, or he is not living in the real world. I am referring to the sentence, "Physicians must now obtain approval from colleagues to order tests or perform extensive evaluations." Every physician that I know of who is in a managed care organization and who orders test, workups, and treatments for his or her patients never consults with or gets approval from a "colleague." Instead, the office staff is on the telephone for 45-minute intervals, seeking approval for an x-ray film from an authorization person sitting in front of a computer making sure that certain criteria are fulfilled before a test can be ordered. This "approval process" delays treatment, creates a bottleneck, is inefficient, and passes the costs on to physicians and their office staff, while enabling insurance companies and managed care organizations to delay, deny, and alter care with the bottom line being greater and greater dollars in their pockets.

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