QIOs sometimes have "conflicted" relationship with nursing homes

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Quality Improvement Organizations see themselves more as partners of nursing homes and other healthcare organizations working to improve care rather than regulators, according to an analysis of the organizations.

The QIOs "sometimes play a conflicted and controversial role," according to The Washington Post, which examined QIOs as part of a three-part series on Medicare. The federal program spends nearly $300 million a year on QIOs, a network of 53 private groups.

Contributing to its less regulatory role: Healthcare consumers have a small presence on QIO boards and some QIOs have become highly profitable businesses, paying large salaries to executives and board members. In the nursing home realm, QIOs most recently have taken a high profile in the quality improvement movement.

Over the last two decades, QIO sanctions against hospitals and doctors have slipped from an average of 31 per year to an average of one per year, the Post said. In 2003 and 2004, QIOs received an average of one complaint for every 14,000 beneficiaries or 3,100 complaints each year. Complaints were upheld in less than one in four cases.