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Utilization review and the family physician
1Department of Family Practice, Harrisburg Hospital, PA 17101.
Family Medicine
|May 1, 1988
Summary
Family physicians must understand utilization review (UR) programs to navigate confidentiality, financial obligations, and liability. Enhanced education on UR structure and function is crucial for effective participation.
Area of Science:
- Healthcare Management
- Family Medicine
- Health Policy
Background:
- Family physicians frequently interact with utilization review (UR) programs.
- Traditional UR encompasses hospital-based services like prehospital certification, concurrent review, and discharge planning.
- The scope of UR is expanding into ambulatory care, emphasizing resource allocation.
Purpose of the Study:
- To inform family physicians about key issues in utilization review.
- To highlight the importance of understanding UR for cost-effective resource management.
- To advocate for enhanced family medicine education regarding UR programs.
Main Methods:
- Review of traditional and emerging roles of utilization review programs.
- Analysis of critical issues impacting family physicians in UR interactions.
- Discussion on the implications of UR for patient confidentiality, financial liability, and medical malpractice.
Main Results:
- Family physicians face challenges related to confidentiality, financial responsibility, and liability within UR.
- The influence of UR on resource allocation in ambulatory settings is growing.
- Current family medicine education may not adequately prepare physicians for UR engagement.
Conclusions:
- Family physicians require comprehensive knowledge of UR programs for informed participation.
- Educational curricula should integrate UR principles to equip practitioners for future healthcare landscapes.
- Proactive engagement with UR is essential for maintaining quality of care and managing practice risks.