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HRD-81-26 1 (1980-12-29)

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BY TH E         njWC~ .      jO~e                             I~ /yo /(


Report To The Subcommittee


On Oversight, House Committee


L__   o


On Ways And Means

OF THE UN TED STATES


IEL EASED


Department Of Health And

Human Services Should Improve

Monitoring Of Professional

Standards Review Organizations


Professional Standards Review Organizations
(PSROs) are designed to assure that health
care services provided under Medicare and
Medicaid are delivered as effectively, effi
ciently, and economically as possible


GAO reviewed the records of 809 patients
that had 1,779 days of their hospital stays
denied for payment because PS ROs determined
that hospitalization was not necessary on these
days An additional 384 days of care should
have been denied if the patients' care was re-
viewed in accordance with applicable regula-
tions and requirements Monitoring of the
PSRO program by the Department of Health
and Human Services was not sufficient to make
program officials awareof such noncompliance

The benefits of extending PSRO authority to
perform hospital discharge planning appears
questionable
This report also discusses paying for physicians'
services provided on dayswhere hospitalization
is not necessary and controlling PSRO type
costs incurred by delegated hospitals


114140


      HRD 81-26
DECEMBER 29,1980

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