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QIOs Begin Effort to Build Support for Burgess Bill

By John Reichard, CQ HealthBeat Editor

JULY 26, 2006 -- Under fire from the Senate Finance Committee, organizations that contract to improve care to Medicare beneficiaries have begun the delicate task of building support for legislation that would widen their role. At a Hill briefing on Wednesday, the organizations sought to educate congressional aides on their various projects and demonstrate that their efforts are truly improving care quality.

The "QIOs," short for Quality Improvement Organizations, also have aligned themselves with physicians seeking an overhaul of Medicare's physician payment formula. Both the QIO lobby, the American Health Quality Association, and the biggest physicians' lobby, the American Medical Association, weighed in this week in support of a bill introduced Monday by Rep. Michael C. Burgess, R-Texas, that would boost physician payment while expanding the role of QIOs.

Hanging over the QIOs is an investigation by the Senate Finance Committee, whose leaders have urged the Medicare program not to broaden the role of QIOs until questions about possible financial improprieties on their part have been resolved.

Also needed is a "more thorough evaluation" of QIOs' effectiveness in improving quality, said Senate Finance Committee Chairman Charles E. Grassley, R-Iowa, and ranking member Max Baucus, D-Mont., in a recent letter to the Center for Medicare and Medicaid Services.

"Medicare shouldn't promise to pay more for a pig in a poke," Grassley said in a press release May 12.

Grassley has raised questions about the salaries and travel expenses of QIO executives and board members. AHQA has said that QIOs agree reforms are needed and that virtually all of the organizations have adopted standards governing QIO board structure, executive and board compensation, and appropriate travel.

The Burgess bill (HR 5866) reflects the recommendations of a recent Institute of Medicine study calling for the expansion of the role of QIOs so any provider can obtain their help improving quality. Nursing homes, for example, have sought the assistance of QIOs in redesigning their procedures for caring for elderly patients to lower the incidence of bed sores, which can be fatal. But because of funding limitations QIOs have limited the assistance they provide.

Grassley has yet to weigh in on the Burgess QIO provisions but QIOs themselves sought to convince aides of the efficacy of their organizations at Tuesday's briefing.

One QIOs' main activities of is working with hospitals to measure and improve the quality of their care. Dale Bratzler, medical director of a QIO called the Oklahoma Foundation for Medical Quality, told the briefing that hospitals working with QIOs showed improvements in treating heart and pneumonia patients four times greater than that of other hospitals, according to the 2005 National Healthcare Quality Report, an annual report on the nation's health care quality issued by the Agency for Healthcare Research and Quality.

Bratzler also noted another project in which QIOs are involved, the Surgical Care Improvement Project, aims to reduce preventable illness, injury, and death related to surgery by 25 percent by 2010 . The program aims to better prevent post-surgical infection, heart attacks, blood clots, and pneumonia. About 2,000 hospitals are taking part in the effort, he said.

QIO-initiated efforts have helped increase from 48 percent in 2002 to 73 percent in 2005 the percentage of hospital patients getting antibiotics at the right time and have helped reduce surgical infection rates by 27 percent, he said.

Bratzler also noted a recent statement by quality guru Donald Berwick, president of the Institute for Healthcare Improvement in Cambridge, Mass., crediting QIOs for the success of his "100,000 Lives Campaign," which recently estimated that 122,300 lives had been saved in participating hospitals that retooled systems of care.

It's unclear how successful those statistics will be in building support for the Burgess bill in light of the Grassley probe. The Burgess bill is also an iffy vehicle for the QIO provisions because of its inclusion of physician payment revisions that would cost scores of billions of dollars to fund.

But for now the link to the Burgess bill and the involvement of the AMA has elevated the profile of the QIO provisions on Capitol Hill. Also giving them a boost was the appearance at the briefing of John C. Nelson, whose tenure as president of the American Medical Association recently ended and who now serves as the medical director of a QIO operating in Utah and Nevada.

Nelson suggested that even if the Burgess bill in its current form isn't enacted, the QIO provisions might yet go forward. If there is going to be a physician payment bill of any kind, he said—referring to a more limited bill—it would be linked to quality improvement, he said.

That cost—plus the complexity of overhauling the sustainable growth rate (SGR) formula for Medicare physician payment—has slowed action on the issue.

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