Abstract
Utilization review is required as a prerequisite to participation in medicare (PL 89-97). Experience with such mechanisms has been restricted to a few areas in this country. The Hospital Utilization Project of Western Pennsylvania has developed an extensive mechanism for identifying areas of hospital practice which would warrant attention by a medical-staff utilization committee. Its approach, a technique of pattern review rather than the case-by-case approach, uses comparative statistics on length of stay for specific diagnostic categories to indicate the utilization patterns of the hospitals participating in the project. The provision in the medicare law which requires recertification of extended-care cases might divert effort from the more comprehensive utilization-review activities.
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