Medicare quality improvement organizations, or QIOs, often are lax in taking strong action against healthcare providers that provide substandard care to patients, according to a new report from HHS inspector generals office.
A major purpose of the QIOs is to review the care provided to Medicare beneficiaries and recommend corrective actions to improve poor quality care, said Sen. Chuck Grassley (R-Iowa), ranking member on the Senate Finance Committee and the senior lawmaker who called for the study. Instead, were getting a soft approach that too often accepts poor quality or turns a blind eye.
Grassley said he wants to see the CMS overhaul the QIO program, which is slated to be funded at more than $400 million this year and next.
But the American Health Quality Association, which represents the nations collection of QIOs, said the organizations are following the orders the CMS set out for them. The agency gives QIOs a lot of latitude to find and then fix instances where poor quality of care exists, according to David Schulke, the associations executive vice president. The CMS, for instance, directs QIOs to utilize the least intrusive action(s) necessary to correct the behavior involved, he said in a written statement.
The agencys instructions in this regard represent a judicious exercise of the governments power, Schulke said.
In its report, HHS inspector generals office said that QIOs reviewed 318,018 cases during a three-year span between 2003 and 2006. Of those cases, the QIOs reviewed 34,768 for quality-of-care issues, while the overwhelming majority of them were under review for payment-related issues.
The office found that in 80% of those cases, QIOs let the providers off too easily, finding either that care could reasonably have been expected to be better or care failed to follow generally accepted guidelines and usual practice. The office also found that in those cases that were selected for issues other than quality, QIOs found quality concerns in 61% of them. Further, the QIOs rarely initiated sanction activity in response to a confirmed concern, the report indicates.
The CMS contracts with QIOs to oversee and improve the quality of care that Medicares more than 40 million beneficiaries receive. -- by Matthew DoBias