Pros inquiry results now being disclosed

   The Peer Review Organization's (PRO) reviews are no longer confidential due to the recent decision of a federal court ruling in the District of Columbia, Public Citizen, Inc v. Department of Health and Human Services, et al.  If a Medicare patient or their family complains about a physician's care, the Medicare PRO must tell the patient or patient's representative what the inquiry has found.  HHS and HCFA attorneys have not yet stated if the agencies are planning to appeal the decision.

   Before this case, the Health Care Financing Administration (HCFA) had prohibited the disclosure of results of PRO investigations.  In this recent court decision, it was decided that HCFA's PRO regulations conflict with the Peer Review Improvement Act of 1982.  According to the Act, PROS must inform the individual (or their representative) of their conclusion about the complaint. The Act also stated other provisions such as having any PRO data acquired remain confidential (except under specific written circumstances) and authorized HCFA to issue regulations controlling the circumstances that allow information to be disclosed.

   The new ruling will require HCFA to disclose results of PRO investigations and must send letters to PRO investigators informing them that they are required to disclose the results of  investigations made to beneficiary  complainants within twenty days of Court's July, 2001, ruling.

   In accordance to the new ruling a treating physician will not be asked to consent to the release of information for a patient who request a PRO review.  PROS will be forced to provide the results of their investigation to questioning Medicare beneficiaries.  Physicians should be aware that their identity could be exposed in the disclosing of this information.