The above material represents a detailed discussion of the GMCF quality review plan, the quality intervention plan, and the sanction plan. It should be clear that every effort is being made by GMCF-PRO to provide fair, realistic, and commonsense quality of care reviews to the physician and hospital community of Georgia. It should also be evident that GMCF interventions will focus on education. Practicing physicians of the appropriate specialty are involved at every level of the review, intervention, and sanction process. Due process is afforded to physicians and hospitals in each plan as described above. The practicing physician community should recognize the obvious need for active participation in the PRO review process to provide proper balance and perspective to quality of care reviews. The GMCF 29-member board (23 physicians) is committed to the concept of maintaining practicing physician involvement and participation in the HCFA-PRO program as mandated by Congressional legislation. It is necessary also for GMCF to continue with close communication to MAG and all specialty societies in order to ensure the recruitment of specialty physician consultants for a quality chart review program, review of screening criteria, and review committee participation.

Georgia↗

PubMed1989

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)

Georgia↗

PubMed1989

PRO review Part II: Surgical review activities.

Explore the source record for details and available documents.

Ambulatory Surgical Procedures↗

PubMed1987

Chloramphenicol-resistant Salmonella newport traced through hamburger to dairy farms.

Explore the source record for details and available documents.

Animals↗

PubMed1987

Selected arthropod-borne diseases. Plague, Lyme disease, and babesiosis.

The incidence of plague, one of the oldest arthropod-borne diseases, has increased during the past 10 years in the United States. Domestic carnivores are playing an increased role in the occurrence of human cases. The cat is now the principal cause of primary human pneumonic plague in the United States. Lyme disease and babesiosis, which were initially thought to be limited to specific local regions, are much more widespread than originally thought.

Animals↗

PubMed1985