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Illinois medical license defense attorneysHow many patients can healthcare providers treat while maintaining adequate care? Some patients would be surprised to learn that their physician might see up to 2,500 patients a year—visits during which the physician has to deliver all recommended preventive, chronic, and acute care services required. Nurse staffing has faced this problem as well, with short-staffing at hospitals leading to rising nurse-to-patient ratios. How can these healthcare providers sufficiently handle such clinic loads while providing adequate care?

For physicians, the answer heavily relies on effective delegation of workload. In a 2012 study by the University of California at San Francisco’s Center for Excellence in Primary Care, if a primary care physician does everything on their own, from screening, counseling, immunization, drug prescription, chronic care, and treatment of acute conditions, the physician could only accommodate a maximum panel of 983 patients.

Of these tasks, the time physicians spend on preventative services could be delegated to non-clinician care-team members. Those hours spent managing common chronic conditions could be delegated to other hospital personnel, such as nurses and medical assistants. In appropriately delegating these tasks, it allows a doctor more time to appropriately treat the greatest number of patients while ensuring proper care and treatment.

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Third-party payer interferenceWhen seeking out medical treatment, the most important relationship that arises is between the doctor and the patient. One of the main problems threatening that relationship is third-party payer interference. Third-party payers have seen a rising power in the exam room over the actual doctors treating patients. While the medical field has sought to empower patients in making their own medical decisions, third-parties are interfering with this ability. How have third-party payers acquired such influence?

Even though doctors are taught to recognize the patient as top priority, third-party insurers make the ultimate determination related to patient access to treatments and medications doctors have recommended, not only to improve patient health, but to save their lives. As unfathomable as it may seem, it is fairly common practice for patients to be denied the treatments their doctors have described. Patients are often unaware that when insurers deny this access, they can appeal the decision and fight to receive the treatment their doctors recommended. However, obstacles to overturning the insurers’ denial, even if patients are aware of this option, often scare off patients from pursuing claims.

As frustrating as denial is on the patient side, it likewise hinders a doctor’s ability to most effectively treat their patients. It is generally unethical to deny a patient treatment, especially if other treatments have proven ineffective. Yet, doctors are required to jump through third-party insurers’ hoops to eventually provide the treatment they recommended in the first place. For instance, certain types of therapy treatment require that a patient must first fail on a less expensive medication, even if it is likely to be less effective. Doctors also find themselves caught up in a situation where patients must independently prove they require the treatment or medication recommended by a doctor. Patients must demonstrate this through a doctor using certain diagnostic procedures or lab studies in coming to a conclusion regarding treatment.

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