Profile Based Dental Utilization Review System

摘要

This project assessed the effectiveness of a profile-based surveillance and feedback (SF) utilization review system that focused on dentists with very high utilization rates. Claims data from three national insurance carriers were used to select 1764 general dentists who were assigned randomly to a test or control group. Test group dentists who had very high utilization rates (N=93) for one or more services were informed of their unusual practice patterns. After 7 months, dentists who had not reduced their utilization rates were re-contacted. At the end of 14 months, 56 percent of cited services were reduced significantly and 85 percent of practices reduced one or more service compared to controls. Per patient charges for cited services were also reduced significantly (17%).