Mills3186, great insight into how you actually experienced it. Doctors are under a lot of pressure to follow these guidelines. Who would want to have part of their pay taken away because they can't convince someone to follow the advice of the benchmarks and best practices! The patients should have the right to make an informed decision regarding their healthcare. The only thing the doctor should do is document the non-compliance with the " Benchmark or Best Practice" and that should be the end of it, but unfortunately it is not. To Queasy27: I know that with certain insurance companies, you are "flagged" by the insurance company by some circumstances. I am not sure what exactly sets off the flag but it could be something like multiple ER visits for high blood sugar or high blood pressure. The insurance company sees these claims when submitted and they feel you, for some reason, cannot keep your blood sugar or blood pressure under control. They will send you a letter stating that they recommend you start a medication or have a "Nurse Navigator" help you manage your health care. They work with you over the phone to try and prevent you from continually going to the ER. So when a medical practice sees that you have gone to the ER, they want you to come back for a follow up appt to try and educate you, review your medications and try and prevent it from happening again. ER visits are very expensive and some insurance companies give a medical practice a certain amount of money to manage a certain number of patients. So if the medical practice goes over that amount, it comes out of their pocket. That is where the "Best Practices" come into play.
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