Medicare

Reviews of Quality of Care at Participating Hospitals Gao ID: HRD-86-139 September 15, 1986

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

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.

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