Medicare: Reviews of Quality of Care at Participating Hospitals
HRD-86-139
Published: Sep 15, 1986. Publicly Released: Sep 15, 1986.
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Highlights
GAO reported on the quality of medical care provided to in-hospital Medicare beneficiaries, specifically the Health Care Financing Administration's (HCFA) increased requirements for utilization and quality control peer review organizations (PRO) to monitor the quality of care provided.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Health Care Financing Administration | The Administrator, HCFA, should require PRO to include quality-of-care review data available from the 1984 through 1986 contract period in their profiling of hospitals and physicians. |
Closed – Not Implemented
Although HCFA should have required PRO to do this to ensure that profiles or abberant providers were available early in the contract period, it is now too late for this action to be useful.
|
| Health Care Financing Administration | The Administrator, HCFA, should require PRO to, as part of their discharge reviews, include an assessment of the appropriateness of discharge destinations to better ensure that patients needing skilled nursing care are allowed to remain in the hospital while awaiting placement in a nursing home. |
Closed – Implemented
HCFA has added an explanatory note to its discharge planning generic screen indicating that an acceptable discharge plan must address the unique needs and circumstances of each individual patient. This change became effective in April 1987.
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Topics
Health care cost controlHealth insurance cost controlHealth services administrationHospital care servicesMedicarePhysiciansQuality of careHospitalsSkilled nursingBeneficiaries