New approaches to physician reimbursement will require pathologists to redefine their role as leaders in hospital-based healthcare organizations. Accountable care organizations will emphasize cost effective high quality care in which fee for service is replaced by a global payment for an episode of care. Practicing pathologists will be required to assume new professional roles that demonstrate the value of pathologists within the health care system. Utilization management is one such role in which pathologists equipped with the appropriate knowledge and skills can become leaders in the design of new models of care. Current and future models for reimbursement of health care will increasingly focus on controlling unnecessary utilization while improving the overall quality of care. Many studies have described individual initiatives to control the utilization of one or a few tests. However, there is little published experience with establishing an ongoing utilization management program (UMP).  

Faculty/Authors
LMU Committee

CME/CMLE Credit: 1.5
Estimated Completion Time: 1.5 hour
Format: Online Educational Activity and Post Exam

Physician Competencies: Medical knowledge

Eligibility for CME/CMLE Credit: Max three attempts. You will have a maximum of three attempts to meet the following criteria:

• Module ≥80% = CME/CMLE credit
• Module <80% = No CME/CMLE credit, after a maximum of three attempts

Accreditation Statement: The American Society for Clinical Pathology (ASCP) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education (CME) for physicians. This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME).

Credit Designation Statement: The American Society for Clinical Pathology (ASCP) designates this journal-based CME activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Instructions

To claim CME/CMLE credit for the exercise, do the following:

1. Review the Technical Considerations.
2. Click Go to Course to view an overview of the modules in this course.
3. Click Access to begin the course.
4. Review the Educational Activity.
5. Complete and submit the Post Exam. You will have a maximum of three attempts to obtain the required score. You will be notified if you have met the credit requirements after each attempt.
6. Submit the course Evaluation.
7. Enter the maximum number of credits offered and click Claim CME to register credit.

The faculty have no relevant financial relationships with commercial interests to disclose

Technical Considerations

Release Date: 10/8/2014  
Review Date:
Expiration Date: 9/30/2026  

• The Importance of establishing an Interdepartmental utilization management organizational structure.
• Selection of utilization management intervention tools to ensure successful implementation.
• Design of informatics solutions to monitor utilization data and design of interventions.
• Cost accounting for Utilization management.
• The role of pathologists in leading a UMP.