• developed and refined instruments for data collection
• assessed office environments for safety, cleanliness,
  accessibility, staffing, scheduling, and confidentiality safeguards;
• reviewed medical records for the quality and appropriateness of care:
• applied disease management protocols for common diagnoses.

PRIMARY VERIFICATION OF CREDENTIALS

For clients with either large or small provider networks the PSRC has worked either onsite or at the client's office or in close coordination with client staffs.  For tens of thousands of physicians, through the established PSRC access to national and state databases, the PSRC has:

• confirmed current valid license;
• confirmed clinical privileges in good standing at the primary admitting facility;
• assured valid DEA or CDS certificate;
• confirmed Board certification;
• verified work history;
• assessed malpractice history and confirmed current and adequate malpractice insurance;
• confirmed previous or current state sanctions, restrictions or limitations of scope of practice;
• reviewed physician application for correctness, completeness and appropriate attestation;
• evaluated client policies and procedures to assure appropriate verification practices and quality assurance mechanisms are in place and functioning.

FOCUSED PHYSICIAN-TO-PHYSICIAN REVIEW

PSRC physicians work with HMO providers to help improve the quality of care and the utilization of services for subscribers and their families.

DEVELOPMENT OF REVIEW INSTRUMENTS

DEVELOPMENT OF QUALITY AND UTILIZATION MANAGEMENT PROTOCOLS

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Educational Development and Training

The PSRC has trained thousands of professionals to carry out client specific protocols, reviews, evaluations and assessments.  Thoroughly trained personnel provide the standard of excellence required to carry out professionally designed protocols and assessment tools which seek to evaluate and monitor the quality and level of health care delivery services.

To that end, the PSRC has trained:

• Clinical personnel who determine a patient's care needs and the best setting for that care in accordance with federal and state regulations safeguarding patient welfare;
• Home health professionals;
• Hospital discharge planners;
• Registered nurses who conduct site assessments and medical record review for quality and utilization monitoring, level of care assessment, data collection and special studies;
• Nursing home, Hospital and Community Service Agency Registered Nurses and Social Workers as patient review assessors for the New York State reimbursement program for nursing facilities.  (See our page on PRI and SCREEN Information regarding this program.)

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Conference Development

The PSRC has also organized and trained professionals in a variety of conferences on:

• Primary Care and the Management of HIV Infection
• Confidentiality and HIV Testing
• Working with the Provider Community for Onsite Data Collection
• Patient Assessment for Nursing Home Admissions

Innovative Protocols

The PSRC has been responsible for producing state of the art protocols for the treatment of specific diseases.  Working with the physician and nursing community the PSRC, on behalf of state authority, coordinated and assisted in the publication of critical treatment manuals for the care and treatment of HIV infection.

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Medical Record Review

The underpinning for much of PSRC work is medical chart review.  We work in all health care settings including hospital inpatient and outpatient, clinic, private office, nursing home, assisted-living center, mental health facility, day treatment facility, home health, correctional facility infirmary, and others

TO ASSESS

• quality of care
• access to services
• level of care
• utilization of services
• appropriateness and accuracy of all billed costs, including cost of drugs
• clinical appropriateness of care
• compliance with regulatory procedures
• compliance with practice guidelines

TO EVALUATE CLINICAL PROTOCOLS

TO PERFORM OR VALIDATE ICD-9 or CPT CODING

TO COLLECT DATA SUCH AS

• the standardized clinical data sets, HEDIS, etc.
• brand and quantity of all pharmaceuticals administered during selected hospitalizations.

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Additional Services

• Design and implementation of special studies
• Troubleshooting consultation relating to quality and utilization management
• Response to regulatory sanctions
• Mental health and substance abuse review
• Special expertise in AIDS/HIV care

The PSRC's experience in this complex field goes back more than a decade.  During 1988-1991, a period of rapidly expanding knowledge, the PSRC conducted numerous educational conferences for health care professionals and produced one of the first clinical manuals on the treatment of AIDS and HIV infection under the aegis of the New York State Department of Health.  Working with medical experts in the field of AIDS/HIV care, the PSRC developed and implemented a quality of care, utilization and case management program for HIV patients in AIDS designated hospitals in New York.   More recently, the PSRC has conducted medical record reviews and evaluated clinical protocols in non-hospital settings to assess quality of care and case management for HIV patients.

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Clients

PSRC clients include:

• Major insurers
• Managed care companies
• Governmental and regulatory authorities
• Physician provider networks
• Medicaid managed care organizations
• Community health care agencies
• Alternative residential care facilities
• Hospitals and health care facilities
• Pharmaceutical companies
• Professional and trade associations

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