You could hear the clapping and cackling in physicianland last week as UnitedHealth Group announced it will end the onerous practice of medical second-guessing, known euphemistically as "utilization review."
The American Medical Association didn't waste any time in praising United's decision. AMA President Thomas Reardon, M.D., called it "a long overdue victory for America's patients and the care they receive."
He added, "For several years, the AMA has led the fight to give physicians the freedom and autonomy they need to make the best decisions for their patients. We are encouraged that one of the nation's largest health plans has finally agreed."
And other plans probably will agree with United. The industry already had been edging away from the more disagreeable aspects of managed care.
United's calculation that it was spending more than it was saving by playing doctor is a long overdue victory for efficiency and good business sense. United concluded, somewhat late in the game, that there are better tools for controlling costs. Negotiated contracts, profiling of physician practice patterns and disease-management programs are three major and superior alternatives.
The fact that it took years of bad public relations and bad press and a mammoth political fracas in Washington to move United to this point makes you marvel again at the phenomenon of corporate inertia. Despite United's prominent switch, some plans undoubtedly will cling to the self-defeating strategy of utilization review until the bitter end because they always have.
But before then and before the celebrations get out of hand, we would caution physicians against irrational exuberance or irresponsible actions. The era of healthcare cost control is not over. Corporations that must compete in a global marketplace can't afford to hand a blank check to providers. Public payers, often strapped for revenues in a time of tax revolts, can't do it either.
A disturbingly large segment of the physician community believes there will be-can be-a return to the "good old days," when doctors were unquestioned medical monarchs and the nation's wealth was theirs to transfer. If they interpret United's decision as a backward stop in the time machine, these doctors will retreat deeper into fantasyland.