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.
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 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.
Medicare will also spend more money to make provider quality measures available to consumers. Modern Healthcare disclosed Nov. 12 that the CMS intends to unveil a new nursing home quality initiative, which will include posting facility-specific quality measures on the Internet.
The agency also hopes to make PROs' complaint-review process more responsive, quick and efficient. 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.
Last week, a National Quality Forum committee recommended nursing home quality measures to CMS for use in its five-state pilot project. The suggested measures include rates of resident bedsores, weight loss and antipsychotic drug use.