Peer to Peer Reviews: Getting to Patient Centered Outcomes-Session Presentation

Video Transcription

Video Summary

The video transcript provides insights on peer-to-peer reviews in the context of rehabilitation physicians. The speakers discuss the need for patient-oriented outcomes and advocacy for vulnerable and underrepresented patients. They emphasize the importance of understanding and effectively communicating the patient's medical condition and functional status to the insurance reviewers. They highlight the need to tell a compelling narrative by combining medical issues, functional status, and environmental factors. The speakers also mention the use of proprietary admission criteria and the challenges involved in interpreting and discussing these criteria with reviewers. They provide examples of case studies where patients were initially denied inpatient rehab but were eventually admitted after thorough discussions and advocacy. The speakers also touch on the topic of retroactive Medicare denials and the appeals process involved in overcoming these denials. They stress the importance of accurate and thorough documentation, as well as the need to educate the reviewers on the unique aspects of rehabilitation care. The speakers address common challenges faced in the peer-to-peer process, such as inconsistent scheduling and reviewers with limited understanding of rehabilitation. They also discuss the impact of decreased therapy services in subacute care and the opportunity to highlight the need for inpatient rehab. The speakers encourage the use of documentation and therapy notes to support the case for inpatient rehab and advocate for patients' best interests. Overall, the video transcript provides insights into the challenges and strategies involved in peer-to-peer reviews for rehabilitation physicians.

Keywords

peer-to-peer reviews

rehabilitation physicians

patient-oriented outcomes

advocacy

functional status

insurance reviewers

compelling narrative

proprietary admission criteria

retroactive Medicare denials

documentation