PSRO, Politics and Quality Assurance.

a staunch advocate of PSRO as it was originally proposed by Senator Wallace Bennett. His informed commentary carries a clear message: PSRO has been progressively politicized around the issues of cost containment and public disclosure of PSRO data. This, together with numerous changes in the program's administration, has seriously jeopardized its future as a physicians' program of professional self-regulation in quality assurance. Cost control generally is a paramount issue in the Congress and the executive branch of government, and this concern is focused particularly on the highly visible, widely publicized multibillion dollar expenditures under Medicare and Medicaid. This means that PSRO will continue to be viewed by Congress and the Department of Health, Education, and Welfare (DHEW) as an instrument for controlling those expenditures. Confrontations between the private sector of medicine and the government on this issue can at best only result in a standoff. The reason is that even when PSRO'S do what they are expected to do-eliminate unnecessary hospital admissions and days of staythere is no assurance that actual dollars will be saved. The recent evaluation of PSRO performance by DHEW claimed that PSRO'S were beginning to pay for themselves through savings of paper dollars, those assumed to have been saved as a result of reducing hospital use by Medicare and Medicaid patients.' However, a study of the Colorado PSRO by Private Initiative in PSRO* found no relationship between hospital utilization and hospital reimbursements by Medicare or Medicaid.2 Spe-