Reform Update: Groups push CMS to keep QIOs state-based

A handful of healthcare associations and 47 state medical societies are exhorting the CMS to maintain a state-based structure for quality improvement organizations, rather than to permit contracts with QIOs that are regional or national in scope.

This issue began nearly two years ago, when healthcare quality advocates said Medicare's Quality Improvement Organization Program didn't get a fair deal in provisions that were tucked inside a federal trade bill. Those provisions called for eliminating statewide QIO contracts in favor of ones that are regional or national, which the CBO estimated could save about $300 million over 10 years. But quality advocates said that could compromise the close working relationships that QIOs have with providers in their local communities.

The topic has sparked renewed interest lately for a few reasons, starting with the CMS' decision to post a request for information about changes to the current contracting process this spring on the Federal Business Opportunities website. Organizations were permitted to post comments then and they also have an opportunity to weigh in during the current public comment period for the proposed rule for the outpatient prospective payment system. In that rule, the CMS laid out the broad requirements for QIO contracts included in the trade bill, according to Todd Ketch, executive director at the American Health Quality Association. The comment period ends Sept. 6.

In addition to these two formal processes, the American Medical Association and 47 state medical societies wrote a letter to HHS Secretary Kathleen Sebelius and CMS Administrator Marilyn Tavenner in mid-July urging them to maintain the current state-based structure. The groups contend state-based quality organizations can more readily tailor their quality improvement activities to state regulations and also foster solid relationships with their local medical societies and professional boards.

Other groups, including the National Rural Health Association and the American Health Care Association, support the AMA and AHQA's position.

As Ketch explained, the last year of the 10th scope of work for the federally funded QIOs began on Aug. 1 and new contracts for the 11th scope start next August. The contracts last for three years. The CMS is now developing the next phase of the QIO program, he added, and is looking to implement those changes from the 2011 trade law. Ketch said the agency is considering using the input from the request for information process and releasing a draft request for proposals in the fall, then releasing a final contract in December or January. That's why the groups are working to educate the CMS on why it should maintain the status quo.

In a news release, the AHQA cited a study in the Journal of the American Medical Association earlier this year that showed a 6% decrease in both hospitalizations and hospital readmissions among Medicare beneficiaries related to the work of QIOs in 14 pilot communities.

“Every state is different,” Ketch told Modern Healthcare. “Healthcare is a local activity. What we see is there is great need for understanding at the local level of the particular needs of the communities in order to engage them in quality improvement efforts that are going to have the impact that we want.”

A new report produced for the SCAN Foundation—which works to advance a continuum of care for seniors—found that a lack of information, avoidance of thinking about growing older and inexperience with long-term care are the primary roadblocks to Americans planning for their healthcare needs as they grow older. About 65% said they've done little or no planning and only about half (53%) said they have set aside money to help cover those needs. The SCAN Foundation is led by President and CEO Dr. Bruce Chernof, who serves as chair of the federal Commission on Long-Term Care. The commission has scheduled a public hearing in Washington on Aug. 20 to discuss long-term-care services delivery and workforce issues.

U.S. Rep. Jim McDermott (D-Wash.) sent a letter to the Government Accountability Office this week asking for a study on the trend of increasing hospital consolidation. “It is important for policymakers to understand the extent to which hospital consolidation is occurring and how such consolidation is affecting the Medicare program,” McDermott wrote in his Aug. 15 letter to U.S. Comptroller General Gene Dodaro (PDF).

Several major business groups have launched a campaign to repeal the health insurance tax included in the Patient Protection and Affordable Care Act. America's Health Insurance Plans, the National Association of Manufacturers, the National Association of Health Underwriters, the U.S. Chamber of Commerce and the National Retail Foundation have started what they call the Affordable Coverage Project. The tax on insurance policies is expected to raise $8 billion in 2014 alone and $100 billion over the next decade. That money helps pay for the subsidies lower-income Americans will receive to buy health coverage on the state insurance exchanges starting in January. The groups' website does not offer any alternative way of paying for the subsidies. AHIP's members expect to gain millions of new subscribers as a result of subsidized coverage on the exchanges. But the groups argue that the tax will hurt insurers, businesses and government units.

Meanwhile, the conservative group Americans for Prosperity announced it launched a radio ad campaign in six states urging Americans to question whether the ACA will provide them with the best quality healthcare.

Follow Jessica Zigmond on Twitter: @MHjzigmond