Savings Claimed for the Oklahoma Hospital Utilization Review System Were Overstated

The Oklahoma Utilization Review System (OURS) is an alternative to the Professional Standards Review Organization (PSRO) system which reviews Medicare and Medicaid patients' needs for medical care while they are in the hospital. Essentially, OURS is a statistical screening system to assess each hospital in the State in terms of specific performance measures related to utilization. It was funded as a demonstration project through a Department of Health, Education, and Welfare (HEW) grant, and managed by the Oklahoma Foundation for Peer Review. The 12 month demonstration period was extended for another 3 months with no additional Federal funding. In its study of OURS, GAO reviewed Medicare and Medicaid claims data and population statistics relating to Medicaid and Medicare eligibles. Six hospitals in the State were visited to discuss OURS, and officials responsible for monitoring the managing foundation's performance were interviewed.