Utilization Review Committee

Utilization review committee focuses on designing the program to reduce admissions into hospitals and manage the length of inpatient stay in the hospitals it uses various concepts to carry out the process such as preliminary analysis, concurrent inpatient examination, and early planning of discharge activities (Daniels, 2015). This management tool became relevant when the hospitals that were participants in the Medicare program were required under the federal laws to have utilization review plans; they were to offer a review based on admissions, the length of stay and the professional services expected. The plans were to find out the medical need and encourage the effective use of resources.

The utilization review committee has the mandate to formulate the required plans that will see the process of reducing the mentioned hospital admissions. Therefore, its primary purpose was to fulfill the federal requirement of ensuring the necessary controls in the management of hospital resources is in place (Pennsylvania., & Health Information Designs, 1987). The Center for Medicare and Medicaid services set the condition for all hospitals participating in the Medicare program should have the utilization review committees. The committee consists of medical staff and reports to the medical executive of the particular hospital.

The board of directors of each hospital has the responsibility to constitute the utilization review committee; it also has the final say on all matters of utilization of hospital services. The committee consists of one or two physicians appointed by the chief medical officer in the hospital, non-medical staff consultants drawn from case management officers or health information management (Kongstvedt, 2001). Physicians are also part of the committee. The team needs to meet on a regular basis, a minimum of six months in a year. It should follow the hospital policy in maintaining its minutes. The minutes should include recommendations and necessary for the hospital management.

In the committee, there is a slot for the professional and technical personnel that handle various functions including, reviewing of medical records to access data necessary to assist in making decisions in utilization review. The personnel is supposed to review all patients placed in beds and provide the information to the committee (Kongstvedt, 2001). On a general scope, their work is to provide information concerning the use and availability of resources in areas that relate to the work of the utilization review committee.

The federal government and other commercial players have a keen interest in the way various hospitals adhere to the utilization review requirements. The monitoring exercise also extends to the medical and the surgical treatment. The center for medicating and Medicaid maintains contacts with peer review organizations referred to as the Quality Organizations (QIOS) to get feedback on their monitoring activities of hospital utilization activities (Kongstvedt, 2001). Through the reports, CMS can determine which hospitals are not adhering to the federal requirement that dictates that hospitals under the Medicare program must have functional utilization review committees

In conclusion, the utilization review committee is a hospital management tool that assists in the management of patient admissions and the monitoring of the use of resources in health facilities. The federal government created the committees to assist in monitoring and management of Medicare patient admissions and access to health resources in hospitals. The committee provides reports to the hospital management for action.



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