title: Medicare beneficiary complaints about quality of care.
abstract: This study examined all Medicare beneficiary complaints about quality of care submitted to the California Peer Review Organization (PRO) over 18 months. The complaint rate was low, and a medical record review by the PRO only confirmed 13% of the complaints. Managed Care Organization (MCO) members filed significantly more complaints about denial and/or delays in receiving services and the failure to refer to specialists. Fee-for-service complaints focused on inpatient hospital services, particularly premature discharge, discharge planning, admission necessity, and unnecessary tests. The PRO review process took over 7 months, and the findings were generally not released to the complainants.
authors: Department of Social & Behavioral Sciences, University of California, San Francisco, Calif., USA.
authors: C
authors: C
authors: Harrington
authors: J
authors: J
authors: Weinberg
authors: S
authors: S
authors: Merrill
authors: J
authors: J
authors: Newman
mesh_terms: D000368:Aged; D002140:California; D018588:Fee-for-Service Plans / Q000592:standards; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000592:standards; D006278:Medicare / Q000592:standards*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011366:Professional Review Organizations; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D014481:United States