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Medicare peer review organizations
1Ohio State University College of Law, Columbus 43210.
Abstract:
The Medicare Peer Review Organization (PRO) Program is undoubtedly the most ambitious attempt currently operational of a national health insurance program to use external audit to review the quality of medical care. This article reviews the history of the PRO program, including its genesis in the prior PSRO program, and describes the methods that it currently uses for reviewing the quality of medical care and for sanctioning physicians and hospitals that provide care of inadequate quality. Finally, the article reviews the meager data currently available indicating possible limitations in the effectiveness of the PRO program.
Insights
The Medicare Peer Review Organization (PRO) program, a national initiative for external quality audits, faces limited effectiveness data despite its ambitious scope. This review examines its history, methods, and potential limitations.
Area of Science:
- Health Services Research
- Medical Quality Assurance
- Health Policy Analysis
Background:
- The Medicare Peer Review Organization (PRO) program represents a significant federal effort to ensure quality medical care.
- It evolved from the earlier Professional Standards Review Organization (PSRO) program, building upon previous quality assurance frameworks.