title: Managing the interface between primary-care provider and specialist.
abstract: Confusion abounds regarding what constitutes a minimum standard of primary-care management and when it is appropriate to refer. Regardless of the cost-containment methods employed, financial-incentive models applied in the absence of clinical appropriateness criteria may result in implicit rationing of healthcare services. Software-embedded clinical criteria are essential in these changing times.
authors.affiliation: InterQual, Inc., Marlborough, MA, USA.
authors.forename: T
authors.initials: T
authors.lastname: Hongsermeier
authors.forename: A J
authors.initials: AJ
authors.lastname: Mitus
mesh_terms: D002204:Capitation Fee; D019090:Case Management; D002908:Chronic Disease; D005194:Family Practice / Q000458:organization & administration*; D006279:Health Maintenance Organizations / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D007400:Interprofessional Relations; D008511:Medicine / Q000458:organization & administration*; D017060:Patient Satisfaction; D012017:Referral and Consultation / Q000458:organization & administration* / Q000592:standards / Q000639:trends; D012308:Risk Management; D012984:Software; D013038:Specialization; D014481:United States