The QIO program, established by a 1982 law, allows the CMS to contract with one QIO in every state, Washington, D.C., Puerto Rico and the U.S. Virgin Islands. A description from the CMS said these private organizations—which are mostly not-for-profit—are staffed mostly by physicians and other clinicians trained to review medical care, help beneficiaries with complaints about the quality of care and implement quality improvements. The contracts last for a period of three years.
“The most troubling aspect that jumps to mind is this notion that the program might be regionalized or centralized,” said Jennifer Lundblad, president and CEO of Bloomington, Minn.-based Stratis Health, which maintains the QIO contract for the state of Minnesota. “The ability to do that for multiple states and not be based in the state where the work is occurring feels like a huge barrier and a huge disservice,” she said. “We can have national goals and national standards and national evidence. But healthcare is local.”
Another change would allow the CMS to award separate contracts for administrative case review and quality-improvement functions within a contract area—again, on a regional or national basis. Lundblad said splitting up those functions would be contrary to the CMS' push for more coordinated—and less fragmented—care. “So to break apart a quality infrastructure that is working on a continuum of care,” she said, “is counterintuitive to us.”
But Dr. Patrick Conway, chief medical officer in the CMS' Office of Clinical Standards and Quality, said parsing out contracts for various functions actually could be considered more coordinated.
“It gives us the flexibility to determine if this is a quality-improvement effort where we fund 50 different efforts, or one contractor using the same methods across a region that is national in scope,” he added. “There may be some that you do fund 50 different contracts and some where you would have one regional.”