Utilization review and the family physician
Herman, J.M.
Family Medicine 20(3): 215-219
1988
ISSN/ISBN: 0742-3225 PMID: 3417073 Document Number: 305576
Family physicians are often in close contact with utilization review programs. Traditional hospital based review programs have included prehospital certification, outpatient and same-day surgery, second opinions, concurrent hospital review, and early discharge planning. The role of utilization review in ambulatory care is expected to increase in the future and will focus on the cost-effective allocation of resources. Family physicians need to be aware of several issues as they interact with utilization review programs, including the preservation of confidentiality, financial obligation in the face of negative review decisions, and the effect of utilization review on liability for adverse outcomes. Family medicine education should encourage familiarity with the structure and function of review programs and should enable practitioners to participate intelligently in such programs.