November 16, 2001

Medicare PROs headed for major overhaul By Ed Lovern Medicare will transform how it monitors quality of care by increasing consumer leadership at its peer-review organizations and directing the PROs to focus on community initiatives, Modern Healthcare has learned. The 53 state-based PROs, which cost the government more than $300 million annually, will be told to replace their traditional focus on clinical reviews of patient cases to monitor quality with a new emphasis on community projects to improve healthcare. PROs will be renamed quality-improvement organizations under the Centers for Medicare and Medicaid Services' plan, and PRO advisory boards, which have tended to be dominated by physicians and other healthcare professionals, will include more beneficiaries. A new Medicare Quality Improvement Advisory Committee will be made up of equal numbers of beneficiaries, providers, purchasers and other types of healthcare consumers. In addition, Medicare will spend more money to make provider quality measures available to consumers. The Daily Dose disclosed Nov. 9 that the CMS intends to unveil a new nursing home quality initiative, which will include posting facility-specific quality measures on the Internet for consumers. The agency also hopes to make PROs' complaint-review process more efficient, responding to beneficiaries' concerns in a more timely fashion. HHS' inspector general's office in August criticized PROs for being inaccessible to beneficiaries and for rarely responding to complaints with more than a form letter. The PRO changes, along with the nursing home quality initiative, are expected to be unveiled Monday by HHS Secretary Tommy Thompson and CMS Administrator Thomas Scully at a news conference at Woodbine Rehabilitation and Health Center, Alexandria, Va.

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