Medicare:

Reviews of Quality of Care at Participating Hospitals

HRD-86-139: Published: Sep 15, 1986. Publicly Released: Sep 15, 1986.

Additional Materials:

Contact:

Michael Zimmerman
(202) 275-6195
contact@gao.gov

 

Office of Public Affairs
(202) 512-4800
youngc1@gao.gov

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.

GAO reviewed PRO in California, Florida, and Georgia. Although HCFA expanded its requirements for the second contract period for PRO to monitor the quality of care provided Medicare beneficiaries, GAO found that PRO failed to: (1) compile and analyze the data on beneficiaries' substandard care during the first contract period to identify providers with recurring quality problems that might need further review; or (2) monitor whether hospitals were allowing patients to remain in the hospital while awaiting placement in a nursing home.

Recommendations for Executive Action

  1. Status: Closed - Not Implemented

    Comments: 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.

    Recommendation: 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.

    Agency Affected: Department of Health and Human Services: Health Care Financing Administration

  2. Status: Closed - Implemented

    Comments: 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.

    Recommendation: 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.

    Agency Affected: Department of Health and Human Services: Health Care Financing Administration

 

Explore the full database of GAO's Open Recommendations »

Sep 29, 2016

Sep 28, 2016

Sep 15, 2016

Sep 14, 2016

Sep 12, 2016

Sep 9, 2016

Sep 6, 2016

Looking for more? Browse all our products here