PubMed Health⌕ Search
Home/Archive/PubMed

PubMed · 10126349

Avoiding HMO liability for utilization review.

M A Dowell
View original source ↗Export metadata ↓

Abstract

In this article, the author describes the potential liability of Health Maintenance Organizations for utilization review programs. Utilization review is used to determine whether certain medical treatment is necessary according to the standards of the HMO, and the HMO may decline to pay for treatments it deems unnecessary. If a doctor abstains from treatment because of this decision and the patient is harmed, the HMO may become the target of litigation. The author analyzes several recent cases and offers practical ideas for preventing and defending suits brought against HMO's for utilization review decisions.

Explore related subjects

Decision MakingHealth Maintenance OrganizationsLiability, LegalMalpracticeRisk ManagementUnited StatesUtilization ReviewJournal Article

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

M A Dowell. 1993. Avoiding HMO liability for utilization review.. https://pubmed.ncbi.nlm.nih.gov/10126349/

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2003

Efficient literature searching: a core skill for the practice of evidence-based medicine.

BACKGROUND: Efficient literature searching and the application of formal rules of evidence in evaluating the clinical literature are the two key skills defining the practice of evidence-based medicine. Although clinicians embrace the concepts of evidence-based medicine, most identify limited personal time as the major barrier towards its implementation into daily practice. Busy clinicians who practice evidence-based medicine identify systematic reviews and evidence-based clinical practice guidelines as very useful resources. METHODS: This review presents a simple, easy-to-follow, three-step searching strategy that emphasises the use of powerful new PubMed features that allow clinicians to retrieve high-quality systematic reviews, clinical practice guidelines and primary studies with a single mouse click. The overall effectiveness of the process is further improved by highlighting the major features of successful and unsuccessful literature searches. CONCLUSIONS: At the end of this tutorial the reader should be able to conduct efficient and effective literature searches that support clinical decision making in under 10 minutes.

Decision Making↗