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November 20, 1996

Meeting of Managerial Science With MedicineThe Pace Quickens

Author Affiliations

From the Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Conn.

JAMA. 1996;276(19):1599-1600. doi:10.1001/jama.1996.03540190071032

The ordering patterns of physicians are being monitored more rigorously. Health care institutions and managed care organizations know that physicians control, directly or indirectly, a substantial part of the health care dollar through ordering of tests, procedures, and hospitalizations. Thus, the issue of how best to reduce utilization of diagnostic studies, such as radiologic procedures, without detracting from patient management in both the inpatient and outpatient setting becomes imperative.

In this issue of JAMA, Bree et al1 have studied a new utilization management tool—the radiology consultant-gate keeper—for its ability to improve inpatient diagnostic imaging. Their findings, seemingly counterintuitive, showed little or no alteration or reduction in choice of services, despite the necessity or precertification for nearly all examinations. They document that less than 2% of the 3600 requests were denied by the radiologist and that there was no shift away from more costly examinations to those, perhaps, that are