title: Providers question PROs' effectiveness. Critics contend peer review organizations are too costly and fail to improve the quality of care.
abstract: The Health Care Financing Administration (HCFA) established physician review organizations (PROs) to ensure that Medicare recipients receive care that is medically necessary, of high quality, and provided in the appropriate setting. While arguing that oversight is necessary, many healthcare professionals believe PROs do not accomplish what they were set up to do because physicians focus on the possibility of being penalized rather than on improving patient care. PRO critics claim that the program's peer reviewers are not peers of the physician under review and that, to be effective, they should come from the same local area. They contend the best peer review is conducted within the hospital. They believe intrafacility review can be more effective at bringing about improvement because hospital peer reviewers act as supportive, nonthreatening consultants. The confidentiality of the physician-patient relationship is another issue PRO critics raise. HCFA staffers say hospitalized Medicare patients are required to sign a waiver allowing inspection of their charts, but critics counter that waivers are only for the release of records for payment claims. Changes encouraging cooperation between PROs and hospitals could improve the PRO program and enhance quality of care.
authors: R D
authors: RD
authors: Rothschild
mesh_terms: D000574:American Medical Association; D014487:Centers for Medicare and Medicaid Services, U.S.; D003219:Confidentiality; D003365:Costs and Cost Analysis; D010380:Peer Review / Q000592:standards*; D011366:Professional Review Organizations / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D015397:Program Evaluation; D011787:Quality of Health Care; D014481:United States