PHYSICIANS AS PATIENT CARE MANAGERS Position Paper of the AMERICAN COLLEGE OF PHYSICIANS

Continuing pressures to restrain health care costs have stimulated innovative arrangements for the delivery of health care services. A variety of such arrangements involve use of a so-called "gatekeeper" to monitor and control patient utilization of services. The term "gatekeeper" is frequently used to refer to a person that serves as a case manager, responsible for determining what services are needed and for coordinating the provision of appropriate care. By limiting or replacing patients' freedom to self-select use of health care services, particularly highly expensive services (e.g., hospital and specialist services), this mechanism is seen by some government and private health care payers as a means of assuring that needed health care is provided in a more costeffective manner than through traditional fee-for-service arrangements. However, in the context of providing for the medical needs of patients, we believe a more appropriate term is "patient care manager."