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Response to the Institute of Medicine Report Recommendations

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Medicare: New Directions in Quality Assurance PART IX Response to the Institute of Medicine Report Recommendations

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Medicare: New Directions in Quality Assurance This page in the original is blank.

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Medicare: New Directions in Quality Assurance Response to the Institute of Medicine Report Recommendations: Introduction Molla S. Donaldson, Jo Harris-Wehling, and Kathleen N. Lohr Throughout the conference, health care policymakers, and observers of health policy, commented on the recommendations presented in the Institute of Medicine (IOM, 1990) report. This part brings together the papers given by two legislators, Senator David F. Durenberger and Representative J. Roy Rowland; a physician, Arnold S. Relman; two administration spokespersons, Linda K. Demlo of the Agency for Health Care Policy and Research (AHCPR) and Thomas G. Morford of the Health Care Financing Administration (HCFA); and a representative of the Medicare Peer Review Organizations (PROs), William H. Moncrief, Jr. From his vantage point on the Finance Committee, the Labor and Human Resources Committee, and the Environment Committee, Senator Durenberger responds to the IOM report and its recommendations in the context he views as a fragmented national health care policy, with particular attention to health insurance reform. Congressman Rowland, who serves on a number of health-related committees including the Energy and Commerce Committee, the Veteran's Affairs Committee, and the Select Committee on Children, Youth and Families, has offered a wide range of legislation ranging from drug abuse to the environment, transportation, economic development, disabled veterans, and health care. As one of two physicians in the House of Representatives he brings the special perspective of both a lawmaker and a family physician who practiced in middle Georgia for 28 years and who is acutely aware of the current climate of medical practice. Dr. Relman, who provides a physician's response to the IOM report, is the editor-in-chief of The New England Journal of Medicine. He has been an outspoken observer of the American health care system and has commented widely on the effects of regulation and financial matters on professionals. Dr. Demlo is the Director of the Office of Program Development at

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Medicare: New Directions in Quality Assurance AHCPR, an agency that was created in November 1989. She provides an overview of the plans of the new agency and how they correspond with the IOM report's broad recommendations concerning basic, applied, and diffusion of research. Mr. Morford, Director of HCFA's Health Standards and Quality Bureau and an experienced federal bureaucrat, gives the response for the agency that is presumptively most affected by the IOM report. He focuses on new directions of the PRO program as they reflect recommendations and implications of the IOM report. Dr. Moncrief is President and Medical Director of California Medical Review, Inc. (the California PRO) and President of the American Medical Peer Review Organization; before holding these posts he had a long career in the practice of surgery. His authoritative view of the reaction of the PRO community reflects support for the "new directions" proposed in the IOM report, but it also stresses the continuing need for individual record review and for retaining sanctions in cases where they are needed. REFERENCES Institute of Medicine. Medicare: A Strategy for Quality Assurance. Volumes I and II. Lohr, K.N., ed. Washington, D.C.: National Academy Press, 1990.