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PT and the Greater Good

What if You Could Impact the Milliman Guidelines?

Published May 21, 2014 4:51 PM by Dean Metz

When I was working for a managed care company back in New York, the Milliman Guidelines were the book that drove levels of care and reimbursement. Treatments were approved or denied based on what was in that book.

In the UK, the NHS is actually a single payor insurer with each local Clinical Commissioning Group (CCG) deciding which treatments, procedures and services will get funded and provided. They may be provided by the NHS or by private companies depending on the bidding process. The CCG works similarly to the Milliman Guidelines. The big difference though is that tomorrow I may get to influence how they spend the money in our area.

I previously mentioned that our Community Falls Service was up for an award for patient safety. In addition, I believe we've shown that our service saves money in the long term. I will have seven minutes to give a presentation about that tomorrow. In short, our interventions have decreased the rate of falling by 81% in the cohort we followed, with 69% of the patients experiencing no further falls even six months after discharge.

Considering what a visit to Accident and Emergency (A&E) costs the NHS, never mind a hip fracture, by decreasing the number of falls we have decreased the number of hospital visits and associated costs. I have extrapolated figures for that to present to the commission tomorrow. I don't know that I would've had a similar opportunity to affect the Milliman Guidelines back in the US.

By the way, a week from today my colleague and I will travel to London to present on our service, which has put us on the short list of finalists for the National Patient Safety Awards. Wish us luck!

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2 comments

Hey Dean--best of luck with this presentation and congratulations on all your hard work. While it's nice that you save the NHS money, it's even nicer that your patients aren't getting injured.

Mary Lou Stilwell May 22, 2014 8:13 PM

Good luck!!!  

US health care could benefit from this information, if they wanted to.   When you perform a task too efficiently the big health systems do not like it even though it saves money in the long run.

Jason Marketti May 21, 2014 9:29 PM

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About this Blog


    Dean Metz
    Occupation: Staff Development Specialist
    Setting: New York, NY – Newcastle Upon Tyne, Great Britain
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