Way back in the dark ages, I spent some years working for Optimed Medical Systems, which purveyed a medical prior authorization system written in Progress (not at all relational) database and language suite. This was the early 1990s. The point being, of course, that computerized PA moats have been around for decades. In fact, the OMS software was sorta, kinda an implementation of the Milliman & Robertson books in use for some time. The only thing that's really changed today is that the Medical Industrial Complex has leveraged lots more compute and data than was available 30 years ago. And things are so much better now for the unhealthy.
In 1998 (using 1996 data), this is what
the Annals of Surgery thought of M&R Guidelines
Many of the M&R guidelines were found to be at wide variance from the actual length of stay of patients treated for these diseases in North Carolina. For many patients, the M&R guidelines are not applicable. Applying them in an uninformed way--in other words, discharging patients from the hospital too early--may hurt some patients.
Yeah, patients are so much better off with PA moats. "Stop cutting!! The gas passer's time is up!" The Medical Industrial Complex now has a smorgasbord
of choice for denying healthcare.
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