Assuring quality of care under DRG-based prospective payment.

The implementation of the Medicare Prospective Payment System (PPS) has sparked growing concern that economic pressures on hospitals may adversely affect quality of care. Potential problems include: premature hospital discharge, inter-hospital transfers of severely ill patients, and increased performance of high-risk procedures on an outpatient basis. Quality assurance efforts by Peer Review Organizations (PROs) and by individual institutions should help keep these forces in check. It will be necessary, however, to develop better monitoring systems containing both clinical and financial "markers" to assure the medical appropriateness of inpatient, as well as ambulatory, services offered under PPS.