Preadmission Screening of Medicare Patients-Reply

In Reply.— We are struck by the fact that the responders appear to address the concept and cost of preadmission screening and miss the point of the study, which was to determine whether patients were adversely affected by the program. Drs Barone, Lavers, and Radin have concerns regarding the cost-effectiveness of preadmission screening, and we share their concern. What sparked our interest in performing this study, however, was the obviously more important and overriding concern of clinical efficacy. Unacceptable clinical outcomes would invalidate preadmission screening regardless of its cost-effectiveness. Interestingly, preadmission screening constituted a very small part of the federally mandated peer review organization (PRO) program, which is a very cost-effective one. The total annual cost of preadmission screening, including our best estimate of cost in time to attending physicians, office staff, hospital staff, and the PRO, was approximately $500 000. The total savings to Medicare, including the "sentinel effect"