A decade-long effort by quality improvement organizations, or QIOs, to transform themselves from punitive to preventive organizations may have worked too well, leaving gaps in their oversight, a new report from HHS inspector generals office has found.
The office released the findings of an investigation that showed QIOs overwhelmingly assign their two least severe classifications to cases where theyve found one or more quality-of-care concerns. In its recommendations, the inspector generals office said that the CMS should consider whether it needs to revisit its guidance regarding classifications of confirmed quality concerns and corrected actions.
But officials for QIOs argue that the report neglected to highlight the good things they do. In Michigan, we have a great relationship with providers, and its a very quality-oriented atmosphere, said Debra Moss, president and chief executive officer of MPRO, the Farmington Hills-based QIO for Michigan.
In the report, the inspector generals office said that QIOs tagged cases as either care could reasonably have been expected to be better or care failed to follow generally accepted guidelines and usual practice 80% of the timea move that has some federal lawmakers calling on the CMS to reshape the Medicare-run program.
QIOs contract through Medicare to develop performance and quality improvement programs to providers and practitioners alike. At the same time, however, QIOs play a regulatory role, investigating patient complaints.
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 Iowa Sen. Chuck Grassley, ranking Republican member on the Senate Finance Committee, in a statement. But the providers and practitioners, who rely on the QIOs for localized quality and performance improvement help, say they have a different take on the work they do. Last year, the Georgia Medical Care Foundation, Atlanta, reviewed just 31 cases, finding only three quality problems, Will Battles, a spokesman for the Georgia QIO, said. The rest of the time was spent on various quality improvement programs across the state, he added.
The Institute of Medicine, in recommendations made last year, said that the network of QIOs should focus almost exclusively on the quality improvement aspect and move away from case reviews.
David Schulke, executive vice president for the American Health Quality Association, which represents QIOs, said that the organizations are doing the work the CMS has tasked them to do.
Schulke also said that the criticism that QIOs have gone soft doesnt ring true. You dont want to punish as your first recourse, because most of the time the providers and practitioners are not doing something intentionally or out of incompetence, but rather because they need help, he said.