Future Usefulness of Admission Pattern Monitoring System Is Questionable

Gao ID: HRD-85-94 August 20, 1985

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.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

Director: Michael Zimmerman Team: General Accounting Office: Human Resources Division Phone: (202) 275-6195


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