Grassley Requests Documents From CMS Related to Medicare Quality Improvement Organizations
Senate Finance Committee Chair Chuck Grassley (R-Iowa) on Thursday wrote a letter to CMS officials that requests documents related to Quality Improvement Organizations in response to concerns that private Medicare contractors are "not adequately investigating patient complaints about quality," the Washington Post reports.
In the letter, Grassley raises concerns that QIOs -- the private contractors hired in each state to monitor and improve the quality of care received by Medicare beneficiaries -- "have misplaced priorities." Grassley cites interviews conducted by his staff, as well as a recent Post series that examined QIOs (Gaul, Washington Post, 8/13).
According to the Post, QIOs in some cases consider themselves partners, rather than regulators, of hospitals, nursing homes and physicians. Over the past 20 years, QIO sanctions against hospitals and physicians have decreased from an average of 31 annually to an average of one annually (California Healthline, 7/26).
The letter requests a number of documents related to the finances of QIOs and their policies on conflicts of interest. The requested documents include records of trips by CMS officials financed by the private contractors, as well as Medicare audits and evaluations of QIOs. The letter requests documents from QIOs in 14 states.
"The Post's reporting raises a lot of troubling questions," Grassley wrote in the letter, adding, "Secrecy and tax dollars don't mix. ... The taxpayers deserve to know what they are getting for the $300 million a year that they contribute to these groups" (Washington Post, 8/13).
In related news, Medicare plans to launch a three-year pilot program to test whether coverage of adult day care could reduce program costs over the long term. Medicare, which currently covers care provided by visiting nurses and medically necessary care in nursing homes, does not cover day care for beneficiaries.
However, many adult day care centers provide on-site nurses and a number of other services, and some experts maintain that "extra services at most day care centers ... could help patients recover faster and prevent costly complications that Medicare would have to pay for later," Reuters/Boston Globe reports. Balaji Gandhi, an analyst at Pacific Growth Equities, added that coverage of adult day care would reduce the number of Medicare beneficiaries in hospitals and nursing homes -- "costly settings where the outcome is not necessarily better."
The pilot program would allow as many as 15,000 Medicare beneficiaries currently in recovery from any illness that requires care from a visiting nurse to receive adult day care instead. Home health agencies, which coordinate care provided by visiting nurses, would receive Medicare reimbursement to use for their own adult day care centers or to contract with an outside center.
CMS Administrator Mark McClellan said, "Adult day care programs (and) assistant programs ... clearly have a big impact. It seems like it would make sense to coordinate those services with acute health care" (Heavey, Reuters/Boston Globe, 8/14).
Meanwhile, Bush administration officials and private health care companies continue efforts to encourage Medicare beneficiaries to enroll in the new prescription drug benefit. According to the Wall Street Journal, private companies cannot begin to market specific prescription drug plans until Oct. 1, but many companies and plan administrators have begun "offering beneficiaries general information -- in part to boost name recognition and the chance that seniors will be receptive to their product-oriented pitches later."
UnitedHealth Group, Aetna, Walgreen, CVS, Rite Aid and Wal-Mart have launched educational campaigns to encourage Medicare beneficiaries to enroll in the new benefit. The Medicare Rx Education Network -- which includes America's Health Insurance Plans, the National Association of Chain Drug Stores and the Pharmaceutical and Research Manufacturers of America -- also have launched a $5 million advertising campaign to encourage Medicare beneficiaries to enroll in the prescription drug benefit, with more ads expected later this year.
In addition, CMS has posted information on the agency Web site about the language prescription drug plan administrators should use in their ads and plans to publish a multipage ad on the Medicare prescription drug benefit in Parade magazine in September. HHS Secretary Mike Leavitt also plans to hold a "national conversation day" in November to call on relatives of Medicare beneficiaries to encourage family members to enroll in the prescription drug benefit (Lueck, Wall Street Journal, 8/15).
Several lawmakers and Bush administration officials continue to tour the western U.S. to help educate Medicare beneficiaries about the new prescription drug benefit. Summaries appear below.
- Leavitt: Leavitt last week called for a "national conversation" on the Medicare prescription drug benefit during a visit in Los Angeles with McClellan to promote the program to health care providers, social service organizations and local officials (Thermos, Los Angeles Times, 8/13). Leavitt met with Medicare beneficiaries and health officials in St. George, Utah, on Friday and plans to meet with beneficiaries in Salt Lake City on Tuesday to discuss the prescription drug benefit (Stewart, Salt Lake Tribune, 8/12).
- McClellan: McClellan on Thursday visited the Modesto Area Agency on Aging in California to discuss the Medicare prescription drug benefit with representatives of local government, the Health Insurance Counseling and Advocacy Program and AARP (Carlson, Modesto Bee, 8/12).
- Rep. Bill Thomas (R-Calif.): Thomas and California Secretary of Health and Human Services Kim Belshe on Thursday met with a group of Medicare beneficiaries at the Rasmussen Senior Center in Oildale, Calif., to provide information on the prescription drug benefit and answer questions (Behziz, Bakersfield Californian, 8/11).
- Rep. Ed Whitfield (R-Ky.): Whitfield on Thursday in Kentucky held meetings in Henderson and Morgan Field to explain the Medicare prescription drug benefit, with other meetings scheduled in Hopkinsville and Madisonville (Boyett, Evansville Courier & Press, 8/12).