GOVERNMENTIOM report seeks sharper focus for Medicare quality improvement groupsMedicare QIOs warn that the changes could revive some of the unfavorable parts of the old peer review system.By David Glendinning, amednews staff. April 3, 2006. Washington -- Medicare's quality improvement organizations need to get out of the business of investigating beneficiary complaints against physicians, says the Institute of Medicine. A yearlong, congressionally mandated review of the nation's 41 QIOs found that the groups are uniquely positioned to play a vital role in improving the quality of care offered by doctors, hospitals and other Medicare players. But a requirement that these organizations also chase down individual beneficiaries' grievances about the quality of care they receive, review appeals for coverage and assess the appropriateness of Medicare claims only distracts them from their primary mission, the IOM said in its recent report. "While we recognize the importance of the proper handling of beneficiary complaints and case reviews, these organizations have not yet realized their full potential to help health care providers meet the highest quality standards," said Steven Schroeder, MD, a health professor at the University of California, San Francisco, and chair of the committee that authored the report. "The role of QIOs should be to improve health care practice, rather than to supervise or regulate it." QIOs conducted almost 3,000 complaint reviews between August 2004 and August 2005, the IOM stated. The solution offered by the IOM, a nonprofit component of the National Academies of Science, is to relieve most of the quality improvement organizations of the burden of investigating patient charges of substandard care. By shifting this responsibility to a few national or regional contractors, Medicare could allow QIOs to focus on quality improvement rather than on quality assurance. [...]Full text of American Medical News content is available to AMA members and paid subscribers.
Copyright 2006 American Medical Association. All rights reserved.
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