Medicare may not be receiving much value out of the hundreds of millions of dollars it invests in its network of quality improvement organizations, according to a report in the June 15 issue of the Journal of the American Medical Association. The report, however, has been criticized by the organization that represents that network -- the American Health Quality Association.
Johns Hopkins Bloomberg School of Public Health researchers concluded that hospitals in five states and the District of Columbia that participated in the QIO programs were no more likely to show improvement on 15 quality indicators than hospitals without active QIO programs.
The study was based on data from 1999 to 2001, which was the most recent available. QIOs, formerly known as peer review organizations, contract with Medicare and work in three-year cycles to provide quality improvement assistance to hospitals, nursing homes, doctors and home health agencies.
Current funding for Medicare's QIO network is about $400 million annually. During the time studied, researchers said it was about $200 million.
"I think the main finding we found was that quality is improving in hospitals regardless of the involvement of quality improvement organizations," said Claire Snyder, who recently completed her doctorate at Johns Hopkins Bloomberg School of Public Health.
The fact that quality improvement is shown with or without the participation of an active QIO may be attributable to a wide variety of individual initiatives coming together to create a "climate for quality improvement," Snyder said.
"While small in terms of the overall healthcare budget, the investment in QIOs is major in terms of quality improvement," she said. "My study raises important questions about the effectiveness of quality improvement organizations."
Although Snyder's critics at the AHQA agree with her that the data she used was the most up-to-date information available, they said that programs were "substantially revised" in 2002 and that the JAMA report should not be used to evaluate the QIO program as it exists today.
They also said that the study's results were unfairly skewed because it only looked at 17 months out of a 36-month work period.
"This is roughly equivalent to judging a baker's skill by tasting a pie removed from the oven halfway through the baking time," said AHQA President Jonathan Sugarman, M.D., during a press teleconference held earlier this week.
AHQA also released a statement from its executive vice president, David Schulke, that included preliminary data indicating significant positive results from a three-year, 32-state, QIO-led campaign to improve surgical infection-prevention efforts.
The JAMA report looked at quality indicators for the treatment of atrial fibrillation, acute myocardial infarction, heart failure, pneumonia and stroke in the District of Columbia, Maryland, Nevada, New York, Utah, and Washington state.
The report, which concluded "The findings from this study do not support the hypothesis that the QIO program improves the quality of care for Medicare beneficiaries in the inpatient setting," also noted that the Institute of Medicine is currently evaluating the QIO program.
"We hope this study will help inform (IOM policymakers') deliberations," Snyder said.