Managed Care Utilization Review Professionals Base Their Decisions More on Medical Evidence Than the Bottom Line
Manasquan, N.J. -- About half of managed care utilization review (UR) professionals said UR decisions are more a medical decision than a reimbursement decision, according to a survey conducted by The Managed Care Information Center (MCIC).
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Almost 40 percent or respondents said UR is an even mix of medical and reimbursement decisions. And, only 10 percent said UR is exclusively based on reimbursement.
The survey also showed 62.5 percent of respondents said the concept of UR does not reflect a negative image on managed care -- despite the well-publicized "managed care UR horror stories" that are frequently published in newspapers and magazines and/or are shown on television.
Respondents who agreed that UR reflects a negative image on managed care gave several reasons why, including:
- there are too many portrayals (right or wrong) that UR is a cost issue;
- the perception is that UR says "No" and patients cannot get the care they need; and
- the public perceives the insurance company is telling doctors how to practice medicine, which leads to a breakdown in physician-patient trust.
Other results from the survey, including quotes and opinions of the survey's respondents, are currently being featured as one of MCIC's free "Managed Care Stories of the Week," which are located in the News and Industry section of its Web site, http://www.themcic.com.
The story featuring results from MCIC's Survey of Managed Care Utilization Review Professionals is titled "UM/UR Continues to Spark Ethical Debate," and will remain at the site until March 1.
MCIC's "Managed Care Stories of the Week" are provided to more than 4,000 managed care and other healthcare executives through its free e-mail newsletter, "Managed Care Weekly Watch." Managed care and other healthcare executives can sign up to receive the e-mail newsletter at MCIC's Web site.
For more information contact The Managed Care Information Center, 1913 Atlantic Avenue, Suite F4, Manasquan, NJ, 08736, toll-free telephone 1-888-THE-MCIC (1-888-843-6242), fax 1-888-FAX-MCIC (1-888-329-6242), e-mail firstname.lastname@example.org or online at http://www.themcic.com.
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