Contrasting views on utilization management spur discussion

This month's edition of Diagnostic Imaging includes a discussion that comes close to being a point-counterpoint on the merits of third-party utilization review. Articles by Dr. Michael S. Komarow and Dr. James H. Thrall (page 21) debate the use of third-party utilization review as a way to control spiraling imaging costs.

Komarow's article is actually a response to one by Thrall that appeared in the July issue of Diagnostic Imaging ("Utilization management steps onto center stage," page 29, and on the Internet at www.diagnosticimaging.com's July issue posting). Based on the strong response to that article, we agreed to run Komarow's rejoinder and offered Thrall an opportunity to prepare a reply. Taken together, the three articles provide what I think is one of the best discussions of this topic I have seen in some time.

The contrast of opinions is a strategy we use in news articles and one that works well in commentary articles as well. It is an article of faith in journalism-and in other areas such as law and government-that in the clash of viewpoints the truth is often found. I won't claim that we've found truth, but I do believe we have focused a bright light on this topic.

The topic is important-physicians tend not to like anyone second-guessing their decisions-and that importance is growing, mainly because insurers of all stripes are looking for ways to control imaging costs. Whether you believe that outside companies should step in and take control or that utilization control questions are best worked out between referring clinicians and radiologists, I think you'll find the articles enlightening.

John Hayes is editor of Diagnostic Imaging.