Grassley Criticizes Medicare QIO System
Medicare's system for investigating complaints about poor care is "broken" and provides "no benefit to improving the overall quality" of care received by Medicare beneficiaries, Senate Finance Committee Chair Chuck Grassley (R-Iowa) wrote in a letter on Friday to CMS, the Washington Post reports (Gaul, Washington Post, 3/7).
The committee began an investigation into the practices and oversight of Medicare Quality Improvement Organizations in August 2005 after a Post series reported that QIOs -- private, state-based contractors paid by Medicare to investigate patient complaints and oversee quality of care issues -- often fail to investigate complaints and that some executives receive high salaries and perks (California Healthline, 1/6).
In his letter to CMS Administrator Mark McClellan and other CMS officials, Grassley said the committee's investigation has raised "a number of concerns regarding questionable expenditures, board member and executive staff conflicts of interest and the quality and effectiveness of QIO services." He said that the number of complaints investigated seems "disproportionately low" and noted that little of the funding QIOs receive is based on their performance.
Grassley questioned why so few QIO contracts are subject to competitive bidding when there is "sparse evidence to suggest that QIOs are effective." He noted in the letter that board members of some QIOs appear to receive "exorbitant" salaries and that some QIO trustees have traveled to expensive retreats at resorts in the U.S.
In addition, Grassley said that "it appears that some QIOs have financial arrangements or relationships" with board members that "appear to pose conflicts of interest."
Medicare officials on Monday said they are reviewing the letter and added that the QIO program "is improving the quality of American health care."
The American Health Quality Association, a QIO trade group, also called for reforms to the beneficiary complaint process. In a statement, AHQA said Congress should reconsider a law prohibiting contractors from sharing the results of their investigations with patients before obtaining permission from the doctors being investigated. AHQA also said QIOs should be allowed to publish annual quality reports for each state that include data on providers' performance, as well as be able to release the names of providers who have been referred to CMS for enforcement actions.
According to the Post, the Institute of Medicine on Thursday is scheduled to release findings of its own 18-month review of QIOs (Washington Post, 3/7).