Medicare:

Enhancing Health Care Quality Assurance

T-HEHS-95-224: Published: Jul 27, 1995. Publicly Released: Jul 27, 1995.

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Pursuant to a congressional request, GAO discussed quality health care for Medicare beneficiaries, focusing on: (1) how the Health Care Financing Administration (HCFA) plans to ensure that Medicare providers furnish quality care in both fee-for-service and managed care delivery systems; and (2) experts' views on essential quality assurance components. GAO noted that: (1) HCFA has had problems implementing its quality assurance programs which assess whether fee-for-service providers meet Medicare participation conditions, assess whether health maintenance organizations (HMO) meet similar conditions, and review inpatient and ambulatory care furnished under HMO or fee-for-service providers; (2) HCFA does not have a program to assess physicians' care of Medicare beneficiaries in their private offices; (3) the federal government must develop a quality assurance strategy that builds on existing government and private efforts, encourages continuous quality improvement, and obtains key information about providers which is understandable and available to beneficiaries; and (4) HCFA is implementing several initiatives to improve its quality assurance programs, such as increasing emphasis on continuous quality improvement, developing performance measures, and implementing an in depth survey of beneficiaries' satisfaction with HMO.

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