Peer Review

The federal Medicare program proposed new regulations Friday that would deny payment to hospitals and physicians that deliver substandard hospital inpatient care. The new regulations would increase the government's ability "to ensure that Medicare beneficiaries receive high-quality care," said Dr. William L. Roper, administrator of the Health Care Financing Administration.

Re "A below-average audit," editorial, Dec. 14 Thirty of the nation's best school superintendents and senior managers from 17 major city school systems across the nation traveled to Los Angeles this year, volunteered their time to give their best advice to the city's school system -- and the thanks they get from The Times was to question their motives and belittle their efforts. The study -- not an audit but a peer review -- praised the Los Angeles Unified School District for the progress it had made on student achievement and facilities, took it to task on a number of organizational and operational issues and proposed a roadmap for taking the district to the next level -- something the school board asked us for about 14 months ago. That the 300-page report did not cover every issue or spell out every detail suggests that The Times ought to go back to school on how these systems work before criticizing the district and the people trying to help it. MICHAEL CASSERLY Executive Director Council of the Great City Schools Washington, D.C.

In his July 20 column, "State Teachers Fail the Test of Real Reform," Kenneth L. Khachigian misrepresented and manipulated the facts to discredit teachers in California and the California Teachers Assn. The overwhelming majority of the CTA delegation at the National Education Assn. Representative Assembly did support the part of the NEA resolution calling for peer assistance and peer review. In fact, peer assistance is already part of CTA policy. The delegation also expressed strong support for NEA President Bob Chase's call for a "new unionism."

• Providers collaborate to emphasize preventive care for all and the reduction of complications in cases of major chronic illnesses like diabetes and heart disease. • A non-profit hospice emphasizes comfort for the dying over futile chemotherapy and surgery, extending life an average of 10 days and saving $5,150 for every person who dies there. • The one dominant home health agency is non-profit, not owned by doctors ordering treatment that brings them profits.

The presidents of more than 40 of the country's elite research universities--including all the members in the University of California system--have agreed to stop accepting direct congressional research grants that have not been subjected to a traditional competitive review process.

An auditing firm that has come under scrutiny for failing to uncover corruption in the city of Bell has hired an independent accounting company to review its practices as some government agencies review their ties with the firm. CalPERS, the state employee retirement fund, has decided not to give Mayer Hoffman McCann any more work until state Controller John Chiang completes a review of Bell's auditing. Officials in several Southern California cities said they too are waiting to see Chiang's report before deciding what to do. Mayer Hoffman conducts outside audits for numerous California government agencies as well as some federal agencies.

In your Sept. 14 editorial, "Grading the Teachers," you piously extol the very practice today's highly competitive, quality-driven companies abandoned long ago--grading and ranking employee performance on numerical "results," consigning the hindmost to the devil. The late Edwards Deming, guru of the quality movement, believed that most employees had an innate desire to do a good job. The important thing, said Deming, is to examine the process. If you have poor results, it's the system that has to go, not the person.

Re "Tainted medicine," Opinion, April 6 The reason that efforts by the medical profession to reform its conflicts of interest have been, as Dr. Jerome P. Kassirer describes them, "superficial" is that physicians are allowed to police themselves, unlike in some other professions. Peer review is a sacred cow in the medical community, but it is in need of some major doctoring. Consider the police and the airlines, for example, before outside agencies began to police them. And consider their safety records since they have had parts of their functions placed under the direction of independent agencies.