This Article will first examine the problem of health care cost inflation and the payment strategies the Medicare program has adopted to address that problem. It will then discuss the perverse incentives that these payment strategies create, and the role of the PRO program in addressing harmful provider behavior encouraged by those perverse incentives. The Article examines evidence on whether the PRO program is succeeding or failing in this mission, and suggests possible means of improving the effectiveness of the PRO program in policing cost containment. Specifically, it recommends clarifying and strengthening the deterrent role of the PROs, crafting PRO procedures to maximize PRO effectiveness, and networking between PROs and other regulatory entities to enhance PRO effectiveness.
Timothy Stoltzfus Jost, Policing Cost Containment: The Medicare Peer Review Organization Program, 14 SEATTLE U. L. REV. 483 (1991).