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Responses to Questions About Performance Evaluation Criteria for Professional Standards Review Organizations

HRD-82-124 Published: Sep 02, 1982. Publicly Released: Sep 13, 1982.
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Highlights

Pursuant to a congressional request, GAO reviewed the criteria and methodology which the Health Care Financing Administration (HCFA) used in its 1981 and 1982 evaluation of Professional Standards Review Organizations (PSRO). PSRO's are the organizations primarily responsible for assuring that inpatient hospital services are medically necessary, appropriate, and of acceptable quality. GAO was asked to determine: (1) what basis there was for the differences between the 1981 and 1982 evaluation criteria and methodology; (2) why there were dramatic changes in the relative rankings of several PSRO's; (3) whether quarterly assessments adversely influence the HCFA capability to measure the relative performance of PSRO's; and (4) whether HCFA assessments provide a sound basis for terminating PSRO funding for ineffectiveness.

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Budget cutsEvaluation methodsHealth care cost controlProgram evaluationQuality assuranceQuality of careEvaluation criteriaPatient careProfessional standardsBudget reconciliation