effort, and it needs to guard against the inclination of some organizations to work only on “easy” quality-of-care problems. Moreover, the MPAQ may find itself directly or indirectly affecting the Medicare program. This brings it foursquare into the public policy arena, where more extensive accountability and oversight enter the picture.

Thus, in addition to the MPAQ and its MQROs, we have recommended that two other entities—QualPAC and a National Council on Medicare Quality Assurance—be created to form a comprehensive structure to promote, coordinate, and supervise quality review and assurance activities at the national level. Furthermore, we call for a periodic report to Congress that describes the state of quality of care for Medicare beneficiaries and the impact of the MPAQ on quality of care. Because of the importance of these evaluation activities, we also suggest that the Secretary of DHHS establish a Technical Advisory Panel (TAP) to assist in the evaluation efforts. Table 12.3 summarizes the organizational relationships and responsibilities we have in mind.

These two organizations, which are described in more detail below, have four major purposes

• To bring a greater degree of public and scientific oversight and input into the quality assurance program;

• To provide a way for both the MPAQ and the MQROs to avail themselves of the most advanced techniques available through the private sector;

• To provide a basis by which the program itself can be more effectively evaluated; and

• To assist in program management and operations.

The QualPAC would have several main responsibilities. It should provide advice to the Congress on strategies and methods for improving quality of care for Medicare beneficiaries and on areas where quality improvement is needed. It should conduct studies and analyses as needed to form the basis for policy and programmatic recommendations related to MPAQ. A third responsibility would be to analyze aggregate and person-based national data from many sources, including the National Center for Health Statistics, to identify quality problems, such as access, at a population level. It should also integrate existing and new research findings to augment our knowledge about and methods for quality assessment and assurance. Finally, it should serve as a forum for all major interested parties to have a voice in the planning and evaluation of MPAQ activities.

QualPAC would be composed of appropriately qualified representatives of the public who are not officers or employees of the United States government and are representative of professions and entities concerned with or