The Privilege of Self-Regulation The Role of Appropriate Use Criteria

Inherent in the doctor–patient relationship is the desire for physicians to use available knowledge and judgment to provide the best possible care to their patients. In return, physicians hope to earn the trust and respect of their patients and community. Physicians have the historical opportunity of autonomy in their practice and with that comes the responsibility and privilege of self-regulation (1,2). Unfortunately, as health care costs continue to spiral upward, concerns about the overuse and misuse of costly procedures have been amplified. In response, the communities at large, and specifically payers, have implemented volume- and cost-control mechanisms. One approach is to require “pre-authorization” for services—an activity generally felt by physicians and their office staff to be onerous, expensive to operationalize, intrusive on the physician– patient relationship, and lacking educational feedback to improve quality of care. Another questionable mechanism is to arbitrarily decrease payments for services. Paradoxically, this has potential to increase the volume of services, or even worse, result in underuse of services, which may be essential for improved outcomes in a particular patient. Amid this turmoil, many have asked, “Is there not a better way?”