Can we be certain of PRO accuracy and accountability? Inaccurate "report cards" generated by medicare claims data as a marker for laboratory testing in diabetic patients

American Journal of Medical Quality

Volumn 17, Issue 5, 2002, Pages 171-174

  Gruber, Todd ^a,b   Rudnitsky, Benjamin ^a  

^a MONMOUTH MEDICAL CENTER   (United States)

^b Monmouth Medical Center ^*  (United States)

Author keywords

Billing; Database; Diabetes; Medicare; Peer review organization; Quality; Report cards

Indexed keywords

GLYCOSYLATED HEMOGLOBIN; LIPID;

ARTICLE; BLOOD; CLINICAL PRACTICE; DIABETES MELLITUS; DIAGNOSIS, MEASUREMENT AND ANALYSIS; EPIDEMIOLOGY; FORGERY; HUMAN; INFORMATION DISSEMINATION; INSURANCE; MEDICARE; METABOLISM; PROFESSIONAL STANDARDS REVIEW ORGANIZATION; STANDARD; STATISTICS; UNITED STATES; UTILIZATION REVIEW; VALIDATION STUDY;

BIAS (EPIDEMIOLOGY); DIABETES MELLITUS; FRAUD; HEMOGLOBIN A, GLYCOSYLATED; HUMANS; INFORMATION DISSEMINATION; INSURANCE CLAIM REPORTING; LABORATORY TECHNIQUES AND PROCEDURES; LIPIDS; MEDICARE; NEW JERSEY; PHYSICIAN'S PRACTICE PATTERNS; PROFESSIONAL REVIEW ORGANIZATIONS;

EID: 0036727830     PISSN: 10628606     EISSN: None     Source Type: Journal    
DOI: 10.1177/106286060201700502     Document Type: Article

References (16)

1. Epstein AM. Rolling down the runway: the challenges ahead for quality report cards. JAMA. 1998;279:1691-1696.
2. Krumholz HM, Radford MJ, Ellerbeck EF, et al. Aspirin in the treatment of acute myocardial infarction in elderly Medicare beneficiaries. Patterns of use and outcomes. Circulation. 1995;92(10):2841-2847.
3. Asch SM, Sloss EM, Hogan C, et al. Measuring underuse of necessary care among elderly medicare beneficiaries using inpatient and outpatient claims. JAMA. 2000;284:2325-2334.
4. Poor data quality, reporting delays render CA, NY report cards useless. Data Strateg Benchmarks. 1999;3(10):157-160.
5. Colie RC. Challenges for physician executives in the millennium marketplace. Physician Exec. 1999;25(1):8-13.
6. Weil TP. Public disclosure in the health field: is there a relevant option? Am J Med Qual. 2001;16:23-33.
7. Szabo J. Malpractice data bank flawed: GAO. Physicians Financial News. 2001;19(3):1,14.
8. Hofer TP, Hayward RA, Greenfield S, et al. The unreliability of individual physician "report cards" for assessing the costs and quality of care of a chronic disease. JAMA. 1999;281(22):2098-2105.
9. Huff ED. Unreliability of physician "report cards" to assess cost and quality of care (letter). JAMA. 2000;382(1):51.
10. Jencks SF, Cuerdon T, Burwen DR, et al. Quality of medical care delivered to medicare beneficiaries - a profile at state and national levels. JAMA. 2000;284(13):1670-1676.
11. Poses RM, McClish DK, Smith WR, et al. Results of report cards for patients with congestive heart failure depend upon the method used to adjust for severity. Ann Intern Med. 2000;133(1):10-20.
12. Berthelsen CL. Evaluation of coding quality of the HCUP National Inpatient Sample. Top Health Inf Manage. 2000;21(2):10-23.
13. Mainous AG, Talbert J. Assessing quality of care via HEDIS 3.0. Is there a better way? Arch Fam Med. 1998;7(5):410-413.
14. Golden WE, Cleves MA, Johnston J. Health care report cards -validity of case definitions. Arch Fam Med. 1995;4:976-980.
15. Health system creates brand identity with clinical paths, outcomes data, report cards. Data Strateg Benchmarks. 1998;2(3): 37-42.
16. Jencks SF. Clinical performance measurement - a hard sell. JAMA. 2000;283(15):2015-2016.