Can an accreditation system take the irritation out of utilization review?

Article Abstract:

The Utilization Review Accreditation Commission, formed in 1990, has accredited 42 companies with 48 applications pending. Many more firms have used the Commission's guidelines to improve their services. Separately, a number of states are accrediting utilization review companies on their own, often using URAC's guidelines. Nonetheless, health care providers are still dissatisfied with utilization review companies. The AMA wants to require reviewers to use same-specialty physicians from the same geographical area as the physician being reviewed as standards for reducing or denying coverage.

Accident and health insurance, Standards, Services, Health insurance industry, Utilization Review Accreditation Commission

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N.Y. health commissioner opens doctors' eyes to quality lapses

Article Abstract:

New York State Dept of Health Commissioner Mark R. Chassin has seen enough cases of inappropriate medical care to move him to initiate health reform legislation for New York that would include the formation of a state Board of Quality Improvement. The board would develop guidelines for clinical practice. Hospitals and doctors who follow the guidelines and participate in board projects would be exempt from review. Initially, many physicians disapproved of the proposals, but Dr. Chassin has refined the plan and worked closely with doctors to gain their support.

Administration of Public Health Programs, Health Programs-State, Health aspects, Beliefs, opinions and attitudes, New York, Health policy, Health care reform, New York (State), Chassin, Mark R.

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Cleaning house: AMA tightens membership screening; critics say it's not enough

Article Abstract:

The American Medical Association (AMA) has begun screening membership applicants by checking their records on the AMA Masterfile of US physicians. Physicians gaining membership through state societies of the AMA could previously avoid background checks but will now also be screened using the AMA Masterfile. The AMA may also revoke membership of current members after proceedings that may take three months. AMA membership actions are most frequently taken because of sexual misconduct, violating controlled substance laws and Medicaid fraud.

Physicians, Medical professions, Membership, American Medical Association

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