RESUMEN
Peer review is essential for ensuring quality medical care. In the 1980s a physician-plaintiff prevailed in lawsuit filed against peer reviewers who excluded the physician from a hospital's medical staff. The peer reviewers had acted to preserve their own economic interests. A multimillion-dollar verdict against the peer reviewers destroyed the community's only multispecialty practice and received national attention. Congress reacted by passing the Health Care Quality Improvement Act that granted sweeping, legal immunity for peer reviewers but also created the National Practitioner's Data Bank. The combination of the establishment of a public repository for physicians malpractice and medical staff privileging activity in combination with the near complete legal protection of peer reviewers has converted peer review from an evaluative to a punitive process. The peer review process and the laws that govern it should be reformed to regain its ability to improve and assure quality without being a threat to physicians.
Asunto(s)
Revisión por Expertos de la Atención de Salud/legislación & jurisprudencia , Garantía de la Calidad de Atención de Salud/legislación & jurisprudencia , Humanos , Privilegios del Cuerpo Médico , National Practitioner Data Bank , Revisión por Expertos de la Atención de Salud/tendencias , Estados UnidosRESUMEN
The new competitive environment and the recent application of antitrust laws to the health care industry are changing the way in which hospitals do business. This article explores the applicability of antitrust laws to health care, common practices which may be considered in violation of those laws, and offers a solution to the problem in the form of an antitrust compliance monitoring program.
Asunto(s)
Competencia Económica/legislación & jurisprudencia , Economía/legislación & jurisprudencia , Administración Hospitalaria/legislación & jurisprudencia , Reestructuración Hospitalaria/legislación & jurisprudencia , Legislación Hospitalaria , Estados Unidos , United States Federal Trade CommissionRESUMEN
We analyzed Washington State inpatient hospital utilization for 165 AIDS (acquired immunodeficiency syndrome) cases with 344 hospitalizations from July 1984 through December 1985. We found that mean charges per hospitalization were $9,166 and mean length of stay was 13.3 days. In addition, evaluation of two diagnosis-related groups (DRGs 079 and 398) commonly used for AIDS hospitalizations showed that AIDS hospitalizations were substantially more expensive than non-AIDS hospitalizations within the same diagnosis-related group. AIDS-specific diagnosis-related groups may be necessary to achieve a balance between inpatient charges and reimbursements.