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Assuring quality of care for Medicare patients has always been a top priority for The Health Care Financing Administration (HCFA). As today's Office of Inspector General (OIG) reports state, our current cooperative system of hospital oversight "has significant strengths that help protect patients."

At the same time, HCFA agrees with the Inspector General that this system needs to be even stronger. We welcome the OIG's recommendations. They are a valuable contribution during a period when we are taking a broad range of actions to assure the best care for Medicare beneficiaries.

We have incorporated the Inspector General's recommendations into our new action plan, the Hospital Quality Oversight Plan. This plan will ensure that hospitals deliver the high quality of care patients deserve through better oversight and performance monitoring. Hospitals that fail to meet our standards will not participate in our Medicare and Medicaid programs.

We will hold the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the state survey agencies more fully accountable for their performance. For example, in our revised Conditions of Participation regulations, we will more clearly define our priorities for hospital surveys of basic health and safety issues such as medication errors and surgery mix-ups. We will also clarify JCAHO's responsibility in monitoring the performance of accredited hospitals and work with them to conduct more unannounced surveys and perform more rigorous assessments of each hospital's internal quality assurance process.

HCFA will also determine the appropriate minimum cycle for conducting surveys of nonaccredited hospitals. We are strongly committed to establishing a survey cycle for nonaccredited hospitals so they are surveyed as frequently as accredited hospitals.

Our work with the JCAHO and state agencies is extremely important to improve quality of care. Our oversight plan will further our goal of striking the right balance of educational and regulatory activities.

In addition, these new steps will build on HCFA's current efforts in several areas to assure high quality of care for Medicare beneficiaries:

• Conditions of Participation Regulations (CoPs). CoPs are the minimum health and safety requirements that hospitals must meet in order to participate in the Medicare and Medicaid programs. HCFA is currently revising and improving these standards to reflect advances in quality improvement that are occurring in both the public and private sectors. The final Conditions of Participation regulations, expected to be completed by fall 2000, will also incorporate the Inspector General's recommendations and HCFA's Hospital Quality Oversight Plan.
  
  
• Performance Measures. HCFA is in the process of developing new, evidence-based quality measures to assure high quality hospital care for all Americans. HCFA has directed Peer Review Organizations (PROs) to establish and develop measures that will provide benchmarks of quality hospital care. Three of the performance measures under development include the rate of beta blocker drugs prescribed for patients hospitalized after a heart attack, mortality rates following surgery, and infection rates following surgery. These performance measures will be an additional tool to be used in quality oversight and will complement on-sight surveys by JCAHO and state survey agencies.
  
  
• Information to Consumers. HCFA is committed to providing better information to consumers, so that they will be able to make better decisions in their health care choices. Traditionally, data to compare hospital performance has not been readily available; however, we are currently exploring several approaches to provide more information to Medicare beneficiaries and other consumers. For example, HCFA is currently coordinating a pilot project to examine how to develop and distribute hospital performance data that will enable consumers to compare the quality of care among hospitals.
  

HCFA's new action plan will incorporate our ongoing efforts with our new initiatives to improve our oversight of the JCAHO and state survey agencies.

Assuring top quality of care is a shared responsibility. It requires cooperation but it also requires discipline on the part of everyone involved. The OIG's recommendations are a valuable contribution toward that effort.