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Data for Peer Review: Acquisition and Use
Results in the Experimental Medical Care Review Organization Program
- RICHARD L. GOLDSTEIN, M.D.;
- JAMES S. ROBERTS, M.D.;
- BABETTE-ANN STANTON, Ph.D.;
- DAVID B. MAGLOTT, M.H.A.; and
- MICHAEL J. HORAN, M.D.
Abstract
Nine Experimental Medical Care Review Organizations (EMCROs) review the process and outcome of medical care, using insurance billing claims or medical record abstracts as the data source. The cost of EMCRO insurance billing claims processing in 1972, including peer review, ranged from $0.47 to $2.50 per claim. Three EMCROs reviewed the necessity for elective hospital admission prospectively for $2.50, $8.50, and $10.02 per case. The EMCROs developed innovative methods for abstracting hospital, nursing home, and ambulatory medical records at a cost of $0.40 to $4.00 per abstract. These EMCRO cost estimates were not derived from uniform accounting methods. Problems of accuracy and comparability of data for peer review are discussed. The EMCRO experience may aid local implementation of Professional Standards Review Organizations (PSROs).
Article and Author Information
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▸From the Quality Assurance Group, Bureau of Health Services Research, U.S. Department of Health, Education, and Welfare, Rockville, Maryland.
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▸Requests for reprints should be addressed to Richard L. Goldstein, M.D., Department of Medicine, Massachusetts General Hospital, Boston, MA 02114.
