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Comparison of the Audit and Accreditation Tools Used By The Health Care Financing Administration, The Texas Department of Insurance, and The National Committee on Quality Assurance: The Cost of Multi-Agency Oversight on Medicare+Choice Plans in Texas

机译：医疗保健融资管理局，德克萨斯州保险部和国家质量保证委员会使用的审计和认证工具的比较：德克萨斯州医疗保险+选择计划的多机构监督成本

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On 1 January 2001, approximately 711,000 Medicare patients lost their Medicare+Choice (M+C) health maintenance organization (HMO) provider. The costly M+C regulatory environment is one reason cited by health plans for their mass exodus from the program. In response, 37 states have passed laws accepting industry-based accreditation as satisfying all or part of state oversight requirements. Texas, however, has not passed such legislation and prepares to increase state oversight on HMO operations. This content analysis study examined the current oversight models used by federal and state government regulators and compared these auditing tools to an industry-based accreditation survey. Results suggest that significant differences do exist among the current models (alpha =. 05) regarding the emphasis they place on the four oversight topics of finance, beneficiary protection and information, quality assessment and improvement, and plan management. By developing a M+C supplement to its current accreditation survey process, the NCQA could eliminate the differences in the models. This initiative would result in lower costs for both regulators and health plans. By law, the health plans would be required to pass along approximately $400,000 dollars in additional benefits to over 361,000 Texans participating in the M+C program.

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McCurdy, R. K.;
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年度 2001
页码 1-156
总页数 156
原文格式 PDF
正文语种 eng
中图分类工业技术;
关键词
Medical services; Insurance; Health maintenance organizations; Patients; Health care management; Medicare;

机译：医疗服务;保险;健康维护组织;患者;医疗保健管理;医疗保险;

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Comparison of the Audit and Accreditation Tools Used By The Health Care Financing Administration, The Texas Department of Insurance, and The National Committee on Quality Assurance: The Cost of Multi-Agency Oversight on Medicare+Choice Plans in Texas

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