Medicare Procedures Labeled Deficient

The first hard look at quality control under recent Medicare reforms has found “serious deficiencies” in procedures that are supposed to protect America’s elderly from incompetent, indifferent or greedy doctors and hospitals, a senior government investigator said.

The review of more than 4,700 cases that were flagged by watchdog Peer Review Organizations as suspicious uncovered a few striking examples of physician ineptitude or hospital indifference to patient health and a general indifference by PROs to policing abuses.

The results of the study, which was released Sunday, prompted an unusual “early alert” by Inspector General Richard P. Kusserow to the Health and Human Services Department, warning privately that the review was uncovering serious problems in the Reagan Administration’s heralded reform program.

“The early findings of our inspection have disclosed serious deficiencies,” Kusserow said in his Nov. 25 memo to C. McClain Haddow, the acting head of the department’s Health Care Financing Administration. “We have found numerous cases of substandard care in which there was little or no action by the PROs.

“We are deeply troubled by the ineffectiveness of the existing procedures used by PROs to review cases of substandard care,” he said. “We believe that it is imperative that HCFA take strong action to place more emphasis on PRO responsibilities.”

Haddow, in his response, told Kusserow that he was surprised by the inspector general’s conclusions and disagreed with the assessment of their severity.

“It is not reasonable to expect that all possible problems will be anticipated or that snags and delays in implementation will not occur,” Haddow said of the problems Kusserow described.

Kusserow said in an interview that he stood by his “early alert,” a copy of which was obtained by the Associated Press.

But Kusserow, who maintains that there is a “big problem out there,” said the cases reviewed covered a period from October, 1983, through last May, a period during which the reforms were in their early stages and review organizations were still new.