Peer review advocates are guardedly optimistic that their role in preserving quality will cushion them from the Medicare budget cuts being contemplated by Congress.
They are being buoyed by support from some nontraditional allies-healthcare provider trade groups.
"If Republicans proceed on budget cuts.....they will be vulnerable on the quality issue," a Democratic House aide told a meeting of the American Medical Peer Review Association last week in Washington. "You need to make a case that you are part of the solution, not part of the problem."
AMPRA Executive Director Andrew Webber agreed. "Nothing is over until the budget season is over, but we feel confident that one of the programs that needs to be preserved (from budget cuts) is quality assurance," Webber said.
The aide predicted that as the debate on Medicare spending reductions moves forward, the issue of preserving quality will loom larger and larger.
"The Q-word (quality) has been the last refuge of scoundrels for some time, and we are perfectly willing to*.*.*.*make a pact with the (American Medical Association) and attack Republicans on quality," the aide said.
Peer-review organizations also hope to sell their services to the Republican majority on Capitol Hill as a cost-reduction measure. Since the inception of the Health Care Quality Improvement Program in 1993, PROs have improved their ability to spot incidents of overutilization, saving the Medicare program money.
For example, data from one PRO study on reducing unnecessary prostate surgery showed a 75%. reduction in radical prostatectomy, which resulted in savings of more than $1.3 million for the five hospitals studied. If the program was implemented by the entire nation, AMPRA testified before Congress last month, projected Medicare savings of more than $1.7 billion would occur.
Since 1993, PROs have moved from a punitive, case-by-case review system to a broader evaluation of patient care. The new system has grudgingly won over some groups that had been critical of the peer-review program.
Federal budgets for peer review program 1984-1996
Note: The first round of PRO contracts covered 1984 and 1985. After that, all contracts are for three-year periods.
Sources: American Medical Peer Review Association, for 1984-1994; Clinton administration's fiscal 1996 budget, for 1995-1996.