In response to these alarming statistics, Dr. Joe Kiani, founder of the Patient Safety Movement Foundation, stated in a recent U.S. News & World Report article, “The only way to do something about it is for the entire ecosystem of people involved in health care – whether it’s doctors and nurses and hospital administration, or medical technology companies or government or patients – commit themselves. It can’t be just talk. It’s got to be action.”
The role of Utilization Review Organizations (UROs) in reviewing requests for treatment for injured workers is integral to a healthy healthcare ecosystem. Unfortunately, disparities in minimum performance expectations, quality standards, and fragmented processes across UROs can leave accountability unattended and the safety of injured workers at risk.
California is one of many states to recognize URAC accreditation as a highly valuable tool in the utilization review process, now requiring UROs to become URAC accredited by June 1, 2018. The value for UROs is they will have the infrastructure in place to comply with a nationally accepted set of standards and best practices and provide assurances they are in compliance with UR requirements.
However, it should be understood that URAC accreditation is not just a check off list of things to do and be done, but a dedicated organizational commitment to rise to a higher level of industry performance. It is an arduous process to both obtain and maintain, but the rewards can be plentiful for everyone involved in the utilization review process. More importantly, it helps UROs make a positive contribution to the healthcare ecosystem by ensuring care is not only medically necessary, but safe.