Evolution of Quality Review Programs for Medicare: Quality Assurance to Quality Improvement

This article outlines the development, successes, and future directions of the Medicare Peer Review Organization (PRO) program. As established by the Tax Equity and Fiscal Responsibility Act of 1982, the purpose of the PRO program is to promote the quality, medical necessity, and appropriateness of services reimbursed through Medicare. We describe the evolution of the PRO program from a retrospective quality review approach, focused on individual events, to a proactive, quality improvement approach. Priorities for future development are described, including the identification of additional clinical areas for attention, improvements in program infrastructure, and broadening the scope of projects to new provider settings.