Discussion: Utilization Review and the Practice of Medicine
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.
- Does UR constitute “practicing medicine,” and if so, should UR be limited to only those medical professionals licensed to practice medicine?
- Discuss who you think should head the utilization review program and justify your answer.