internal quality assurance programs of practitioners and providers (as well as report it to the MPAQ); and (5) to carry out quality interventions and technical assistance to internal, organization-based quality assurance programs.

This information will serve important monitoring functions. MQROs must be able to identify providers at both ends of a “quality distribution” if they are to direct needed corrective action and to spotlight and reward exemplary performance. They should, however, be perceived by all providers and institutions as a source of objective, valid, comparable information that will facilitate priority-setting for and evaluation of internal quality assurance activities. To serve this public good function, MQROs, with guidance from MPAQ and outside help from technical assistance contractors, must devise reliable, valid, and sensitive methods for analyzing and disseminating data.

We expect that in many instances MQROs would be (or be similar to) the organizations with which the Health Care Financing Administration (HCFA) presently contracts through the PRO program. We do not believe that these entities must be statewide organizations. Instead, they might operate at substate, state, or multistate levels, depending on what configuration appeared to best suit the practicalities of data collection, analysis, and feedback, geography, and population.

MQRO activities should not be regarded as simply expanded PRO tasks, and not all that the PROs currently do should be part of the MQRO agenda. Rather, MQRO responsibilities will be redirected in line with the emphases shown in Table 12.1 to give a far more central role to data collection, analysis, and dissemination and to fostering internal quality assurance programs.

Public Accountability and Evaluation

RECOMMENDATION NO. 4. Congress should establish a Quality Program Advisory Commission (QualPAC) to oversee activities of the MPAQ and to report to Congress on these activities.

RECOMMENDATION NO. 5. Congress should establish within DHHS a National Council on Medicare Quality Assurance to assist in the implementation, operation, and evaluation of the MPAQ.

RECOMMENDATION NO. 6. Congress should direct the Secretary of DHHS to report to Congress, no less frequently than every two years, on the quality of care for Medicare beneficiaries and on the effectiveness of MPAQ in meeting the goals outlined in recommendation no. 2.

We believe that the MPAQ and the impact it has should be rigorously evaluated. It needs to be accountable for public monies expended in this



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