New report says Medicare QIOs need overhaul

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Proposed changes to Medicare Quality Improvement Organizations could mean providers get more technical assistance and the investigation of beneficiary complaints gets handed off to another agency.

While healthcare quality has improved in recent years, there is inadequate evidence that the QIO program has contributed directly to those improvements, according to a recent report from the Institute of Medicine. The IOM report, which is mandated by Congress in the Medicare Prescription Drug, Improvement and Modernization Act of 2003, does suggest that the potential exists for a revamped QIO program to have a measurable positive impact on the quality of care for Medicare beneficiaries.

QIOs should become "an integral part of strategies" to improve the nation's healthcare quality by becoming available to all Medicare providers. They should also emphasize technical assistance for them, the IOM said in its report "Medicare's Quality Improvement Organization Program: Maximizing Potential."

Providers that have worked with a QIO on an intervention showed greater improvement than those that did not, according to the Centers for Medicare & Medicaid Services. The IOM recommends that the improvement organizations be freed up to concentrate on helping providers improve the quality of care they offer and suggests that QIOs' work of investigating Medicare beneficiaries' complaints should be handed off to other organizations.

The American Health Quality Association, which represents the 41 QIOs with CMS contracts, said it disagreed with that recommendation because the two functions often are interrelated.

QIOs have been under scrutiny from Senate Finance Committee Chairman Charles E. Grassley (R-IA), who recently has questioned their effectiveness, financial dealings and possible conflicts of interest with provider organizations.