Case Management

CMW Tip of the Week: Evaluate your facility's UR committee

Case Management Weekly, March 11, 2009

This week’s tip comes from Karen Zander, RN, MS, CMAC, FAAN.

A fundamental component of a case management service and the hospital at large is the active presence of a utilization review (UR) committee as part of the medical peer review and governance infrastructure. How do you know if your UR committee is effective or not?

Here are some signs of a dysfunctional UR committee:

  • Members are bored and don’t come, or if they do come, they don’t contribute
  • The meeting keeps getting cancelled
  • The minutes have the same agenda every month
  • No data gets reviewed and there are no actionable items
  • No responsibilities are delegated and/or there is no follow-through on delegated items

Here are some signs of a functional UR committee:

  • Meetings occur at least quarterly and minutes are taken
  • Most of the members attend most of the time, including the physician members
  • The UR committee is connected formally to other physician committees as well as hospital committees such as ethics, quality improvement, and patient satisfaction
  • The UR committee has up-to-date data that is trended and displayed in user-friendly ways
  • The UR committee evolves its title to the case management committee, the clinical resource management committee, the clinical integration committee, etc.

Have a tip or tool you’d like to share? Or maybe a question for our experts? E-mail it to editor Julie McGinley at thoughts could be featured in the next issue of Case Management Weekly!

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