Future Usefulness of Admission Pattern Monitoring System Is Questionable

HRD-85-94: Published: Aug 20, 1985. Publicly Released: Aug 20, 1985.

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GAO reviewed the Admission Pattern Monitoring System (APM), which the Health Care Financing Administration (HCFA) designed to identify hospitals that had changes in admission patterns for use in determining which hospitals are most likely to have medically unnecessary admissions.

GAO found that APM was not an effective management tool for monitoring hospital admissions because: (1) due to faulty design assumptions, it incorrectly identified many hospitals as having potential problems; and (2) it duplicated more reliable admissions monitoring systems. In 1985, HCFA stopped using APM to review hospital performance, but plans to use APM to evaluate peer review organization (PRO) activities. GAO agreed with the HCFA decision to discontinue using APM as a tool for identifying hospitals for PRO review of admissions practices; however, GAO is concerned about the proposed HCFA use of APM data as a PRO evaluation tool because: (1) hospital selection would result in information applicable only to the hospitals evaluated; and (2) the methodology could give PRO's advance notice of the hospitals where their work will be most closely evaluated.

Recommendation for Executive Action

  1. Status: Closed - Implemented

    Comments: HCFA agreed with this recommendation and has not used APM as a means of evaluating PRO performance.

    Recommendation: The Administrator, HCFA, should not use APM as a means of evaluating overall PRO performance.

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


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