Evaluation of the New Mexico Peer Review System, 1971 to 1973.

by Robert H. Brook, Kathleen N. Williams

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The New Mexico Experimental Medical Care Review Organization (EMCRO) was established to improve the quality of care given to Medicaid patients and to control the costs of such care. This document reviews and evaluates the first two years of its operations. One chapter describes the characteristics of the Medicaid eligibles and recipients; another summarizes inpatient and ambulatory services used and patterns of administrative and medical denials of payment for services billed. Detailed analyses are focused on the effect of the peer review system on injections given during ambulatory visits, especially changes over time in types of injections billed and denied. Contingency tables and multiple regression analyses were used to clarify relationships between appropriate use of injections and physician characteristics and highlight factors associated with higher quality care. Implications of the findings for both the New Mexico and national peer review systems and for other health policy issues were discussed. 122 pp. Ref. 93 Tables

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