Washington Health Policy Week in Review

Washington Health Policy Week in Review is a weekly newsletter that offers selected stories from the daily newsletter CQ HealthBeat.

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Study Finds QIOs Improved Care for Medicare Beneficiaries

By Mary Agnes Carey, CQ HealthBeat Associate Editor

August 18, 2006 -- Medicare beneficiaries received better care under quality improvement organizations (QIOs) in 34 of 41 areas measured by a study published this week in the Annals of Internal Medicine.

QIOs are state-based organizations, staffed with case review and quality improvement medical experts, that contract with Medicare to improve the quality of care given to elderly and disabled Americans. The government spends about $300 million a year for 53 QIO contracts that cover all 50 states, the District of Columbia, Puerto Rico, and the Virgin Islands.

The study found that in nursing homes working closely with QIOs, the number of patients suffering from chronic pain was cut in half. Physicians' offices improved care for patients with diabetes and increased the number of women receiving timely mammograms. The study also found that surgical infections were lowered in hospitals that worked with QIOs.

According to the study, improvements in care were higher for providers with which the QIO worked closely and were greater for the measures for which providers requested and received QIO technical assistance.

In a statement, American Health Quality Association Executive Vice President David Schulke said the study "shows that when QIOs and providers work together, the quality of care improves faster."

On Capitol Hill, leaders of the Senate Finance Committee have urged the Medicare program not to broaden the role of QIOs until questions about possible financial improprieties on their part have been resolved.

In a letter sent in May to the Centers for Medicare and Medicaid Services, Senate Finance Committee Chairman Charles E. Grassley, R-Iowa, and ranking Democrat Max Baucus of Montana urged a "more thorough evaluation" of QIOs' effectiveness in improving quality. In addition, Grassley has raised questions about the salaries and travel expenses of QIO executives and board members.

Separately, legislation (HR 5866) sponsored by Rep. Michael C. Burgess, R-Texas, would boost physician payment while expanding the role of QIOs in Medicare.

The Burgess bill would enact recommendations by the Institute of Medicine to make the quality improvement activities of QIOs available to all providers; guarantee a minimum of funding for QIOs; and require a review of their resources when the organizations' duties are expanded, among other measures. The measure also would establish a system of quality measures in which doctors would voluntarily report data on the quality of their care.

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