Abstract
This study examined all Medicare beneficiary complaints about quality of care submitted to the California Peer Review Organization (PRO) over 18 months. The complaint rate was low, and a medical record review by the PRO only confirmed 13% of the complaints. Managed Care Organization (MCO) members filed significantly more complaints about denial and/or delays in receiving services and the failure to refer to specialists. Fee-for-service complaints focused on inpatient hospital services, particularly premature discharge, discharge planning, admission necessity, and unnecessary tests. The PRO review process took over 7 months, and the findings were generally not released to the complainants.
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