The Health Care Management Guidelines of Milliman and Robertson, a large actuarial consulting firm, are used by health care organizations managing care for 50 million people. The guidelines are rapidly increasing in popularity and have become a force in the marketplace.
The Academy’s new "Health Policy Update on The Use and Misuse of Milliman and Robertson Guidelines" provides a brief background on the guidelines, issues that some orthopaedists have brought to the Academy and some tips regarding the guidelines in the managed care setting. The orthopaedic issues are:
The Health Policy Update recommends that orthopaedic surgeons find out which, if any, clinical guidelines are used by their health care plans and to learn what the guidelines intend to accomplish. Another point to consider: "Recognize that your performance can be hurt, in the eyes of the health plan, by inefficiencies in your area, as well as in the areas of care associated with the case, but not directly in your control."
The full text of the Health Policy Update will be included with the electronic version of the February Bulletin in the "Library" section of the Academy’s home page (www.aaos.org).