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October Fact vs. Fiction Resource
Health plans’ utilization review guidelines can evidence the standard of care.

What do you think - fact or fiction?

ANSWER: Fiction!

Clinical practice guidelines can definitely be used to determine the applicable standard of care, but these are authoritative guidelines, such as those developed by the APA and AACAP.  They are not UR guidelines from payers.  Also, following the guidelines does not necessarily mean there is no negligence.  And the reverse is true - not following the guidelines does not automatically mean there is no negligence. Guidelines are just one of many factors that can be used to determine the applicable standard of care.  (For our new resource on the standard of care, click here.) Your professional judgment is always determinative. If you decide to deviate from an authoritative guideline, your reasoning for that determination should be documented. 

Click here to read all previous Fact vs, Fiction resources.