California billing fraud alleged: outpatient surgeries said charged as inpatient.
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Biomedical subjects
Publications and source records attributed to W F Jessee.
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Continuing medical education (CME) should be broadly defined as any intervention into the activities of a physician that produces behavioral change. Under this definition, it is unquestionable that CME influences quality of care. However, the current CME-accreditation system, with its narrow emphasis on course work, serves to inhibit the development of individualized educational activities geared to identified needs.
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The professional standards review organization (PRSO) program offers both a challenge and an opportunity to the academic medical center. Application by the local PSRO of objective measures of the quality and medical necessity of services challenges the medical center to demonstrate that its self-image of excellence is correct. Educating and training medical students and house staff in methods of self-evaluation and peer review could have a major impact on both the success of the PSRO program and the quality of medical care. Evaluation of the educational programs of the medical center through review of actual practice behavior presents an unparalleled means for improvement in undergraduate, graduate, and continuing medical education.
The major purpose of the PSRO program is to improve the quality of medical care. Peer review is expected not only to detect problems but to analyze causes, and to develop, implement, and evaluate corrective programs. Such peer-review efforts are in themselves educational. In addition, educational programs focusing on identified deficiencies must be organihe educational efforts of local health facilities and organizations of all types is urged. Although PSRO's will not specifically underwrite continuing health-care education, they should provide a community-wide means for integrating patient-care review with continuing medical education.
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Healthcare providers face increasing financial risk as the federal government continues to refine the DRG-based prospective payment system. Healthcare providers that survive must establish systems that provide information in resource need, consumption and cost. The process illustrated in this article will help healthcare providers identify and establish the necessary systems.
The internal quality assessment and assurance activities in U.S. hospitals can be described in terms of four specific programs: quality assurance, utilization review, risk management, and patient/guest relations. Quality assurance also depends on a strict control of licensing for the health professions, with state and federal involvement, and on a robust malpractice complaint system.