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Utilization management (UM) was defined in 1989 by the Institute of Medicine (now the National Academy of Medicine) as "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient-care decisions through case-by-case assessments of the appropriateness of care prior to its provision."1

Its use has greatly increased in the years since, with troubling implications. Treating cost of care as an outcome metric can confuse the objectives of health care by mixing together processes and results. It can lead to overzealous prospective denial of care, as well as to retrospective denial of payment.

APTA has created an extensive toolkit to help steer physical therapists (PTs) through this changing landscape. More on that shortly. First, let's take a closer look at the phenomenon itself, and the association's concerns on behalf of the profession of physical therapy.

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  1. Institute of Medicine. Controlling Costs and Changing Patient Care? The Role of Utilization Management. National Academies Press, 1989.

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