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Controlling Costs and Changing Patient Care?: The Role of Utilization Management (1989)

Chapter: Appendix D - Summary of Public Hearings

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Suggested Citation:"Appendix D - Summary of Public Hearings." Institute of Medicine. 1989. Controlling Costs and Changing Patient Care?: The Role of Utilization Management. Washington, DC: The National Academies Press. doi: 10.17226/1359.
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Page 250

Appendix D
Summary of Public Hearings*

The Institute of Medicine Committee on Utilization Management by Third Parties held a public hearing on June 6, 1988, at the National Academy of Sciences building in Washington, D.C. Speakers from 27 organizations made presentations to the committee. A question and answer session followed each panel of three speakers. Eight groups submitted written testimony without any oral presentation.

Each of the organizations represented fell into one of five categories or interest groups (Table D-1 lists the organizations by category):

• Practitioners and Organized Medicine

• Health Care Institutions, Associations, and Suppliers

• Patients, Consumers, and Public Health Organizations

• Insurers and Utilization Management Firms

• Trade Associations and Other Organizations

The testimony reflected diverse sets of interests and perspectives on utilization management. There were differences of opinion over the appropriate role of the physician (and/or medical profession) in utilization management; the validity of the criteria currently being used; the impact of various approaches on cost, quality, and administration of services; criticisms or shortcomings of utilization management; and suggestions about what is needed for the future.

* This summary was prepared by Eileen Connor.

Suggested Citation:"Appendix D - Summary of Public Hearings." Institute of Medicine. 1989. Controlling Costs and Changing Patient Care?: The Role of Utilization Management. Washington, DC: The National Academies Press. doi: 10.17226/1359.
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Page 251

TABLE D-1 Organizations Presenting Testimony at the Public Hearing on Utilization Management by Third Parties

Practitioners and Organized Medicine

 

American Academy of Child & Adolescent Psychiatry

 

American Academy of Otolaryngology

 

American College of Physicians

 

American College of Utilization Review Physicians

 

American Dental Association

 

American Medical Association

 

American Psychological Association

 

American Rheumatism Association

 

Coalition to Preserve Quality (written only)

Health Care Institutions, Associations, and Suppliers

 

American Hospital Association

 

American Pharmaceutical Association (written only)

 

Hospital Association of Pennsylvania (written only)

 

National Association of Ambulatory Care

 

National Association for Private Psychiatric Hospitals

 

Mayo Clinic (written only)

Patient, Consumer, and Public Health Organizations

 

American Public Health Association

 

National Health Law Program

 

Public Citizen-Health Research Group

Insurers and Utilization Management Firms

 

ALTA Health Strategies, Inc.

 

Blue Shield of California (written only)

 

Celtic Life Insurance

 

Health Care COMPARE

 

Health Data Institute

 

Health Management Strategies International, Inc.

 

Iowa Foundation for Medical Care

 

Quality Standards in Medicine, Inc. (written only)

 

U.S. Administrators

Trade Associations and Other Organizations

 

American Association of Preferred Provider Organizations

 

Blue Cross and Blue Shield Association

 

Group Health Association of America

 

Healthcare Financial Management Association (written only)

 

Health Insurance Association of America (written only)

 

InterQual

 

Joint Commission on Accreditation of Health Care Organizations

 

National Association of Quality Assurance Professionals

Despite the differences of opinion, however, there was considerable agreement on the following:

1. Utilization management is dynamic; it is evolving; studying utilization management now is like trying to focus on a moving target.

2. There is a proliferation of external review entities in the marketplace with different criteria and a variety of approaches to managing utilization.

3. There are variations in medical practice.

4. Criteria for appropriate medical care are imperfect.

Suggested Citation:"Appendix D - Summary of Public Hearings." Institute of Medicine. 1989. Controlling Costs and Changing Patient Care?: The Role of Utilization Management. Washington, DC: The National Academies Press. doi: 10.17226/1359.
×

Page 252

5. Resources are limited (There is disagreement as to how limited, that is, how much the United States is willing or able to devote to health.)

6. Utilization management highlights the quality and cost debate in health care.

7. There are potential dangers in utilization management by third parties.

8. Utilization management does not seem to influence physician practices. (There is disagreement on how, why, and if it is good or bad.)

9. Utilization management needs physician involvement. (There is disagreement on the type and amount of physician involvement.)

10. Current utilization management programs do little or nothing in the areas of outpatient and office practice and/or monitoring for underservice.

Suggested Citation:"Appendix D - Summary of Public Hearings." Institute of Medicine. 1989. Controlling Costs and Changing Patient Care?: The Role of Utilization Management. Washington, DC: The National Academies Press. doi: 10.17226/1359.
×
Page 250
Suggested Citation:"Appendix D - Summary of Public Hearings." Institute of Medicine. 1989. Controlling Costs and Changing Patient Care?: The Role of Utilization Management. Washington, DC: The National Academies Press. doi: 10.17226/1359.
×
Page 251
Suggested Citation:"Appendix D - Summary of Public Hearings." Institute of Medicine. 1989. Controlling Costs and Changing Patient Care?: The Role of Utilization Management. Washington, DC: The National Academies Press. doi: 10.17226/1359.
×
Page 252
Next: Appendix E - Summaries of Committee Site Visits to Utilization Management Organizations »
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Utilization management (UM) has become a strong trend in health care cost containment. Under UM, some decisions are not strictly made by the doctor and patient alone. Instead, they are now checked by a reviewer reporting to an employer or other paying party who asks whether or not the proposed type or location of care is medically necessary or appropriate.

This book presents current findings about how UM is faring in practice and how it compares with other cost containment approaches, with recommendations for improving UM program administration and clinical protocols and for conducting further research.

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