title: Impact of prospective peer review on pacemaker implantation rates in Massachusetts.
abstract: Preapproval of elective permanent pacemaker insertions in Medicare patients is now mandatory for reimbursement. Of 1,860 requests for approval of an initial pacemaker implant in Massachusetts, 1,494 (80.3%) met strict Medicare guidelines and were approved by a nurse reviewer, and 366 (19.7%) were referred to an independent physician because of a question of appropriateness of indication or type of pacemaker. Only five requests (0.27%) were denied because of an inappropriate indication for pacing. On a second review of these records, an additional eight pacemaker insertions (0.43%) were deemed to have been inappropriately approved. Comparison of the annualized number of pacemaker requests for the study period with those of the 3 years before mandatory approval revealed a reduction of only 3.7%. Thus, contrary to previous findings in other areas of the country, in Massachusetts, inappropriate pacemaker insertions are rare and the effect of the prior approval process is minimal.
authors.affiliation: Department of Medicine, Boston City Hospital, Massachusetts 02118.
authors.forename: R H
authors.initials: RH
authors.lastname: Falk
mesh_terms: D006331:Heart Diseases / Q000628:therapy*; D006801:Humans; D008404:Massachusetts; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D010380:Peer Review; D011446:Prospective Studies; D012017:Referral and Consultation