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HRD-85-94 1 (1985-08-20)

handle is hein.gao/gaobabntw0001 and id is 1 raw text is: UNITED STATES GENERAL ACCOUNTING OFFICE WASHINGTON, D.C. 20548 HUMAN RESOU CES 0WISION August 20, 1985 C. McClain Haddow 128138 Acting Administrator, Health Care Financing Administration Department of Health and Human Services Dear Mr. Haddow: Subject: Future Usefulness of Admission Pattern Monitoring System Is Questionable (GAO/HRD-85-94) The Admission Pattern Monitoring System (APM) originally was designed by the HeaLth Care Financing Administration (HCFA) to identify hospitals that had changes in admission patterns as a means of identifing hospitals most likely to have medically unnecessary admissions. APM was less effective than anticipated as a management tool for monitoring hospital admissions because it (1) did not reliably identify hospitals with questionable admissions practices, and (2) duplicated more reliable admission monitoring systems. Recognizing APM's limitations, in January 1985 HCFA informed its regional offices of APM's cessation. HCFA is considering, however, using APM as a tool to identify hospitals where the effectiveness of the new Peer Review Organizations' (PROs') activities will be comprehensively evaluated. We are concerned that APM could be counterproductive as a PRO evaluation tool in that (1) as proposed, hospital selection would result in information applicable only to the specific hospitals evaluated, rather than findings projectable to a broader universe and (2) the methodology could, in many instances, give PROs advance notification of the hospitals where their work will be more closely evaluated. We would encouraqe HCFA to consider these factors before making the final decision on this matter and to formulate an alternative evaluation metho- dology which would allow statistical projection and minimize the opportunities for PROs to predict hospital selection. BACKGROUND Until October 1, 1983, Medicare generally reimbursed hospitals for medical services provided to program beneficiaries based on the costs of providing such services. Because of concern that this reimbursement system did not give hospitals (106265)

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