Lawmaker again pushes state-based QIOs

Rep. Tom Price (R-Ga.) is making another attempt to undo provisions in a 2011 trade bill that would restructure the Medicare quality improvement organization program.

As part of the trade bill passed in October 2011, Congress permitted QIO contracts to be regional or national in scope, as opposed to their traditional state-based structure.

Healthcare quality advocates say the changes would compromise the relationships that QIOs have with providers in their communities. With Rep. Ron Kind (D-Wis.) as his co-sponsor, Price introduced the Quality Improvement Organization Program Restoration Act, which would restore a requirement for state-based QIOs. Price introduced the same bill last June in the 112th Congress.

In November, the Georgia Republican sent a letter to HHS, urging HHS Secretary Kathleen Sebelius to use her discretion and not impose the trade bill's changes to QIOs as the department prepares for the QIO program's 11th Scope of Work scheduled to begin in August 2014. QIO contracts last for three years. A CMS spokesman confirmed that the agency has been developing regulations that would affect the next cycle beginning in 2014, and that those regulations are “still in the making.”

In a news release praising Price's latest effort, the American Health Quality Association said that the state-based structure for QIOs is important for initiatives that focus on improving quality, such as national campaigns to reduce hospital readmissions and hospital-acquired infections, because “healthcare challenges and circumstances are different in each state.” The association also noted that the trade bill provisions would remove the requirement that local physicians conduct peer review in their own states. Price's bill would reinstate the practice of local physician involvement in the peer review process.

“As a physician, I understand how absolutely vital it is to maintain patient and doctor control over healthcare decisions,” Price said in a news release announcing the bill. “The actions that have been taken to restructure quality improvement organizations will do harm to the QIO program and ultimately threaten the quality of care of Medicare beneficiaries, other patients, families and physicians.”