How we got started...
Professional Standards Review Organizations
To put our work into perspective, it helps to go back to the administration of President Lyndon Baines Johnson, under whose leadership Medicare was enacted in 1965. When that happened, the federal government became the nation’s largest health insurer and as such, had a responsibility to ensure the medical care Medicare beneficiaries were receiving was appropriate. One of the first steps taken was to establish Professional Standards Review Organizations. These were local physician-directed organizations responsible for reviewing Medicare patients’ medical records. There were hundreds of Professional Standards Review Organizations nationwide, and eight in New Jersey – each responsible for a specific region of the Garden State.
The Peer Review Organization of New Jersey, Inc.
In 1982, the federal government moved away from multiple Professional Standards Review Organizations in each state to a single statewide peer review organization. Two of New Jersey’s local Professional Standards Review Organizations banded together and submitted a successful proposal to become The Peer Review Organization of New Jersey, Inc. We were awarded the first peer review organization Scope of Work for the Medicare Program under contract with the Health Care Financing Administration (now known as the Centers for Medicare & Medicaid Services) in 1984.
National Quality Improvement Organization
Our primary work, under three successive contracts from 1984 to 1993, entailed reviewing hundreds of thousands of Medicare patients’ medical records to assess medical necessity, appropriateness of setting and quality of care. In 1993, as a result of a study of the national peer review organization program conducted by the Institute of Medicine, the federal government added a strong quality improvement focus to our work.
Starting with the 1993 contract, we began designing, implementing and evaluating quality improvement projects in collaboration with New Jersey’s healthcare community. Initially, we worked primarily with acute care hospitals and then gradually expanded our quality improvement work to encompass all healthcare settings. Given this expanded focus on quality improvement, the federal government renamed the national peer review organization program to the national quality improvement organization and we eventually changed our name from The PRO of New Jersey, Inc., to Healthcare Quality Strategies, Inc.
