Utilization Management
Although healthcare practitioners such as doctors and nurses occasionally resent the utilization review process, it provides benefits both for consumers and healthcare organizations.Utilization review is described by the National Library of Medicine as a process to evaluate the necessity, appropriateness and efficient use of health care services, facilities and procedures. Growing interest in healthcare reform has expanded the role to utilization management that reaches to all areas of healthcare operations and regulation by federal and state governments.
Appropriate Level of Care
The process of seeking the appropriate level of care for the length of the required treatment helps healthcare organizations run more efficiently while saving money for patients. Patients who need an increased level of care receive needed treatment, while observation patients move through the system in a speedy but care-driven manner. Patient level of care drives staffing which is a huge cost to healthcare organizations and ultimately consumers. Utilization review offers significant insight into day to day operations on a nursing unit, for example.
Shorter Recovery Time
Patients are moved through the system and recover faster than in the days before utilization review. Surgery patients are expected to be up and moving around as soon as possible after the procedure. Research shows that patients who are active recover faster than patients who are more sedentary. On-site utilization review keeps this process on track.
Cost Benefit Ratio
Healthcare organizations benefit from shorter patient length of stay and cost efficient treatment. Utilization review management performs a dual role as patients benefit from shorter recovery periods and healthcare organizations controlling rising costs. Utilization review also means using less expensive treatments when available. While medical practitioners sometimes feel harassed when utilization reviewers question their methods, oversight can be beneficial, and a claims adjudication body is available for protests in the event of a serious disagreement.
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