July 17, 2001
For Immediate Release
Contact: Richard Deutsch
202-331-5790

Statement by AHQA Executive Vice President David Schulke in Response to Court Ruling on Medicare Beneficiary Complaints

We have reviewed Federal District Court Judge Ellen Huvelle's order of July 9, 2001, released yesterday. That ruling orders HHS to instruct all Medicare Peer Review Organizations (PROs) that they must inform beneficiaries of the results of complaint investigations. The national network of PROs is awaiting direction from the Centers for Medicare and Medicaid Services (CMS) regarding the order.

AHQA believes that the Medicare complaint program should be made more responsive and accountable to beneficiaries. CMS must now strike a new balance if the court order goes into effect as written. PROs must provide greater disclosure to a complainant when quality falls below the level of professionally recognized standards of care, while simultaneously working cooperatively with the physician community to constantly improve quality for all Medicare beneficiaries.

The evidence clearly supports the value of collaborative clinical improvement projects undertaken over the past several years by hospitals, physicians, and PROs. These projects have achieved steady improvement in the care of patients suffering from heart attack, diabetes, heart failure and other conditions. This success was achieved because of the professionalism of health care practitioners and the trust between PROs and those practitioners-trust that can potentially suffer as a result of Judge Huvelle's ruling.

Judge Huvelle's order increases the tension in federal law between the interest of individuals who seek full disclosure of complaint investigation findings and the public's interest in encouraging doctors to provide confidential data about quality problems.

Quality improvement depends on prompt acknowledgement and remedy of problems. However, fear of punishment and embarrassment are powerful disincentives for uncovering and drawing attention to problems. The challenge facing the Congress, CMS and the PROs is in reconciling these two very different approaches for assuring patient protection.

The American Health Quality Association represents quality improvement organizations, medical Peer Review Organizations, and health care professionals working to improve the quality of health care nationwide.