The use of ancillary services: a role for utilization review?

Despite both the increasingly high cost of ancillary services such as laboratory tests, x-ray examinations and prescription drugs, and the authority provided to Professional Standards Review Organizations to review their use, ancillary services review remains underdeveloped. Several early programs have used claims review or profile analysis to assess the appropriate use of ancillary services and have claimed effectiveness in reducing medical care costs. Based on this experience, several principles for ancillary services review may be set forth, including problem identification, design of the audit system, determination of requirements for data and development of data sources. Evaluation of model ancillary service review programs is necessary to demonstrate their cost-benefit or cost-effectiveness and their validity.