CMS to more closely oversee finances of QIOs

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The Centers for Medicare & Medicaid Services is taking actions to enhance the ethical standards and effectiveness of quality improvement organizations (QIOs).

The agency is strengthening its financial oversight of the program, improving beneficiary awareness of the QIO complaint and appeals process, and sharpening QIO efforts to provide information on quality and costs to consumers and providers, it said in a report to lawmakers. QIOs are private organizations that work under three-year performance-based contracts with Medicare to increase the safety and effectiveness of long-term care and hospital care.

In March, the Institute of Medicine issued a report that called for a series of changes in the operations of the QIO program. But Senate Finance Committee Chairman Charles E. Grassley (R-IA) questioned the value of the CMS actions. Discussions about the QIO program "need to address whether the current design of the program is even capable of improving the quality of Medicare services," said Grassley, a frequent critic of QIOs.

See the CMS report at