The cost controlling strategy that attempts to influence physician behavior by denying payment for services deemed unnecessary is called.

Question

Options

• ASupply limits
• BUtilization management
• CPatient cost sharing
• DAggregate unites of payment

• A
  2% (1)
• B
  90% (56)
• C
  5% (3)
• D
  3% (2)

Explanation

Utilization management (B) is correct because it specifically targets physician decision-making by reviewing whether services are medically necessary before or after they're provided - and denying payment when they're not. This creates a financial incentive that directly shapes prescribing and ordering behavior.

Why the distractors are wrong:

• A (Supply limits) restricts the availability of providers or facilities, not physician behavior through payment denial.
• C (Patient cost sharing) shifts costs to patients (copays, deductibles), influencing patient behavior, not physician behavior.
• D (Aggregate units of payment) refers to bundled payments (like DRGs), which set a fixed price per episode - they don't involve denying payment for specific services deemed unnecessary.

Memory tip: Think of "utilization" as how much care gets used - utilization management is the gatekeeper that says "you need to justify using that service, or we won't pay."

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