Lawmakers balk at bigger role sought by Medicare quality groups

A quality improvement organization leader says the groups are in an ideal position to help collect data and advise doctors on ways to better their performance.

By David Glendinning, AMNews staff. June 26, 2006.

Washington -- Federal officials have high hopes for Medicare's quality improvement organizations and anticipate that they will play an integral role in quality reporting and pay-for-performance programs in the future. But QIOs might need to assuage some of their critics on Capitol Hill before they can get into position to become such key players.

In a recent letter, Senate Finance Committee leaders asked the Centers for Medicare & Medicaid Services whether QIOs truly are capable of bettering care for beneficiaries. These typically nonprofit organizations contract with the government to improve quality by providing technical support to physicians and others, and by investigating patient complaints against medical professionals.

Several nagging questions must be answered before QIOs should be allowed to have a larger part in Medicare, wrote Senate Finance Committee Chair Charles Grassley (R, Iowa) and Ranking Democrat Max Baucus (Mont.).

"If these organizations are spending inappropriately or failing to actually ensure quality in the Medicare system, those shortcomings have to be figured into any contract and payment agreements," Baucus said in a separate statement. "There are too many unknowns right now to make QIO commitments further into the future."

The lawmakers are concerned that some of these organizations may have too cozy a relationship with the physician practices, hospitals and others that they advise on ways to improve patient care. Because the QIOs also are tasked with looking into beneficiary complaints against some of those same entities, their desire to maintain good working arrangements with the medical personnel might interfere with their ability to investigate the charges fully.