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QIOS Need Clean Bill of Health Before Broader Role, Grassley and Baucus Say

MAY 16, 2006 -- The leaders of the Senate Finance Committee are urging Medicare to hold off on broadening the role of organizations hired by the program to improve quality of care. Questions about possible financial improprieties involving Quality Improvement Organizations (QIOs) need to be answered before that happens, say Committee Chairman Charles E. Grassley, R-Iowa, and ranking Democrat Max Baucus of Montana.

In addition "to these potentially serious problems, there is still a need for more thorough evaluation of the QIOs' effectiveness in improving the quality of health care," the senators said in a May 12 letter to Mark B. McClellan, administrator of the Centers for Medicare and Medicaid Services (CMS).

"We would like our staffs to discuss legislative and administrative changes necessary to ensure that QIOs improve the quality of health care for Medicare beneficiaries, use resources judiciously and adhere to ethical business practices," the senators wrote.

The lobby that represents QIOs recommended to CMS on April 27 that the agency lengthen from three years to five years the contracts awarded to the organizations to assess efficiency and quality in Medicare. The American Health Quality Association (AHQA) also urged that QIOs receive more money to carry out broader responsibilities.

QIOs have grown over the years in terms of the quality improvement programs they are supposed to carry out for Medicare, ranging from helping nursing homes adopt work processes to prevent bedsores to prodding doctors to use health information technology. Grassley, however, has raised a number of questions about salaries paid to QIO executives and board members and payments for their travel expenses.

"Medicare shouldn't promise to pay more for a pig in a poke," Grassley said in a May 12 press release. The Department of Health and Human Services Office of the Inspector General, the Government Accountability Office and the Finance Committee are still gathering facts in investigations of QIOs, he said.

An AHQA official said that QIOs agree that reforms are needed and that any further problems uncovered by the various federal investigations should be addressed by the industry.

"We've stepped up to the plate and say we need to respond to this," said Todd Ketch, AHQA's vice president for government affairs.

Ketch added that 50 of 53 QIOs have adopted standards developed by the industry governing how boards are structured, executive and board compensation, and appropriate travel. He added that AHQA has proposed administrative and legislative changes to CMS to improve QIO accountability.

Ketch said AHQA's call for extending the contract is consistent with the recommendations of a recent Institute of Medicine (IoM) report. Longer contracts would make it easier to evaluate how effective QIO programs are, he said. Ketch also noted that the IoM report said the assistance QIOs provide to improve quality should be available to all providers. That requires more funding for QIOs, he said.

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