Monitor Mondays

Time to Junk the Peer-to-Peer Process?


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"The peer-to-peer (P2P) process is a particularly abhorrent chore for physicians," reports Juliet Ugarte Hopkins, MD, a physician advisor for case management, utilization, and clinical documentation at ProHealth Care, Inc. in Wisconsin. "These phone conversations are generally offered by commercial and managed insurance plans when their clinical case manager or medical director does not feel that inpatient status is supported for a particular patient."

During this episode of Monitor Mondays Dr. Hopkins makes the case for abandoning your P2P process if the results are not satisfactory. Might the pressure of P2Ps even be contributing to some physicians considering opting out of Medicare? Duane Abbey, PhD, president of Abbey and Abbey Consultants, Inc., will review the complexities of compliance facing physicians and practitioners who might consider throwing in the towel.

The episode rundown also includes:

  • Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment.


  • Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO for Nancy Beckley and Associates, has all the latest developments on the therapy caps as well as the Monitor Mondays Listener Survey.


  • Hospice Report: Theresa Forster, BA, vice president for hospice policy and programs for the National Association of Home Care and Hospice, reports on changes to the CMS Hospice Compare program announced Thursday.


  • Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reports on a recent memo from the U.S. Department of Justice offering good news for some providers.
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