Medicare

In response to a congressional request, GAO examined the Health Care Financing Administration's (HCFA) 1988 analysis of Medicare hospital patient mortality.

GAO found that HCFA: (1) modified the composition of the 17 diagnostic categories for Medicare patients to reduce the variation in the mortality rates associated with the individual diagnoses; (2) reported outcomes for each hospital over several years, rather than a single year; and (3) initiated studies to validate its analytical approach. GAO also found that the HCFA analytical approach: (1) failed to account for the wide variations in mortality rates of the principal diagnoses included in many of the 17 categories; (2) lacked detailed clinical data on individual patients; (3) would only provide tentative information on the correspondence between the results of the mortality analyses and the actual distribution of hospital quality problems; (4) did not consider alternative approaches; and (5) did not provide the comprehensive, systematic assessment needed to estimate the effect of any resulting deficiencies on the quality of care.