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Discussion: Utilization Review and the Practice of Medicine

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Critics of utilization review frequently are concerned that many of those persons participating in a utilization review are in fact practicing medicine. Although UR is conducted prospectively, it is used to authorize or refuse proposed treatments, referrals, and even hospital admissions.

  1. Does UR constitute “practicing medicine,” and if so, should UR be limited to only those medical professionals licensed to practice medicine?
  2. Discuss who you think should head the utilization review program and justify your answer.