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HRD-82-124 1 (1982-09-02)

handle is hein.gao/gaobabmop0001 and id is 1 raw text is: - L4'w 11441J7 UNITED STATES GENER, WASHINGTO HUMAN RESOURCES RELEASED DIVISION R r , S . , B-208850 gc . office of~ The Honorable David Durenberger Chairman, Subcommittee on Health Committee on Finance United States Senate The Honorable Max Baucus Ranking Minority Member Subcommittee on Health Committee on Finance United States Senate Subject: Responses to Ques AL ACCOUNTING OFFICE N, D.C. 20548 September 2, 1982 e the9418 119418 tions About Performance Evaluation Criteria for Professional Standards Review Organizations (GAO/HRD-82-124) This report is in response to your June 10, 1982, request that we review the criteria and methodology the Health Care Financing Administration (HCFA) used in its 1981 and 1982 evaluation of Pro- fessional Standards Review Organizations (PSROs). PSROs are the organizations primarily responsible for assuring that inpatient hospital services, and in some cases other services provided to Medicare 1/ patients, are medically necessary, appropriate, and of acceptable quality. You asked: --What is the basis for differences between the 1981 and 1982 evaluation criteria and methodology? --Why were there dramatic changes in the relative rankings of several PSROs from 1981 to 1982? --Does a quarterly assessment 2/ adversely influence HCFA's capability to measure the relative performance of PSROs? --Do HCFA's assessments provide a sound basis for terminating PSROs' funding for ineffectiveness? 1/The 1972 law also included the Medicaid and Maternal and Child Health programs. However, mandatory use of PSROs was removed for these programs by the Omnibus Budget Reconciliation Act of 1981 (Pub. L. No. 97-35). 2/This refers to evaluations of individual PSROs at the end of the quarter in which their grant periods terminate. (106233) U ,33 3

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