Peer review in the 1990s. A look at the Georgia Medical Care Foundation.

Although it is not possible to completely summarize all of the policies and procedures of a program as complex as the PRO program in one article (or even three), it is useful for establishing the framework of these activities over the next 3 years. Many of us are skeptical of the government's role in the medical review process, and some of us can recall specific instances where problems, e.g., backlogs, have diverted us from our primary mission--to insure quality care. It is imperative, as we begin this new PRO contract, that we all recognize what the PRO program is and what it is not. Specifically, it is not a program of quotas wherein GMCF is required to produce a certain number of denials, quality problems, sanctions, etc. It is a peer review program funded by Medicare but implemented by Georgia physicians with a primary focus on quality review. A second point that needs to be made here concerns the scope of PRO findings relative to the volume of cases reviewed. As with any quality assurance program, it is necessary to look at many cases to determine if there are problems. It is important to note here that GMCF recognizes that most health care delivered in Georgia is appropriate. In fact, Mr. Thomas Morford, National PRO Program Director of the Health Care Financing Administration, recently testified to Congress as follows "clearly, the most important observation thus far is that the PROs have not uncovered any systemic quality problems in the Medicare program.(ABSTRACT TRUNCATED AT 250 WORDS)