Quest for quality: medicine cautiously optimistic about new PRO initiative on health care improvement

Article Abstract:

The Health Care Financing Administration plans to test cardiac care in four Medicare professional review organization (PRO) areas. If successful, the program will be extended to the remaining PRO areas and to additional types of medical care. The percentage of hospitalized Medicare cases examined will be reduced from 18% to 12%. Also, medical groups including the AMA will participate in planning. PROs will inspect treatment and outcome for physicians and hospitals to gather uniform clinical data sets. Further details of the plan are included.

Quality management

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Slowly but surely, PROs starting to change focus

Article Abstract:

Medicare plans to revise its handling of peer review organizations (PROs) when fourth period contracts are negotiated in spring 1993. A Health Care Quality Improvement Initiative will collect data on patterns of physician practice and hospital outcomes to set standards for effective performance. Members of PROs are expected to consult with medical organizations concerning changes in criteria. A smaller percentage of cases will be reviewed, and clinical data will by described in standard terms.

Evaluation

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Congress lets volume performance levels rise

Article Abstract:

Congress approved rises in Medicare volume performance standards that allows surgery an 8.4% increase and all other categories 10.8%. Medical groups, including the AMA, urged the adoption of a single standard. Early records show that surgeons held to 1992 payment increase set for them, while other physicians exceeded their limits. Positions of physician groups, the Department of Health and Human Services and the Physicians Payment Review Commission are explained.

Admin. of social & manpower programs, Compensation and benefits, Surgeons

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