Evolution of quality review programs for Medicare: Quality assurance to quality improvement.
Bhatia, Anita J
Date of Pub
Blackstock, Sheila; Nelson, Rachel; Ng, Terry S
This article outlines the development, successes, and future directions of the Medicare Peer Review Organizations (PRO) program.
As established by the Tax Equity and Fiscal Responsibility Act of 1982, the purpose of the PRO program is to promote the quality,
medical necessity, and appropriateness of services reimbursed through Medicare. We describe the evolution of the PRO program
from a retrospective quality review approach, focused on individual events, to a proactive, quality improvement approach.
Priorities for future development are described, including identification of additional clinical areas for attention, improvements
in program infrastructure, and broadening the scope of projects to new provider settings.
Medicare : Quality Assurance, Health Care : Utilization Review : Aged : Program Evaluation : Quality of Health Care : Tax
Equity and Fiscal Responsibility Act : United States : United States Health Care Financing Administration