Senators Call for Reforms to Medicare QIOs
Senate Finance Committee Chair Chuck Grassley (R-Iowa) and committee ranking member Max Baucus (D-Mont.) in a letter dated May 12 asked CMS Administrator Mark McClellan to address questions about the effectiveness of and "possible financial improprieties" involving Medicare Quality Improvement Organizations, CQ HealthBeat reports (Reichard, CQ HealthBeat, 5/16). CMS pays about $300 million annually to 53 private contractors to investigate beneficiary complaints, evaluate quality and work with physicians and hospitals to improve care (California Healthline, 3/10).
The American Health Quality Association, which represents QIOs, in April recommended that CMS increase the contract lengths for QIOs and earmark additional funding to broaden the organizations' responsibilities. Grassley has raised several concerns about QIOs related to executives' salaries and perks for board members.
A report from the Institute of Medicine in March also raised concerns and called for reforms, and the HHS Office of Inspector General, the Government Accountability Office and the finance committee are conducting ongoing investigations of QIOs.
In the letter to McClellan, Grassley and Baucus said CMS should delay actions to broaden the role of QIOs until their concerns can be addressed. They said that in addition to the "potential serious problems" related to possible financial wrongdoing, "there is still a need for more thorough evaluation of the QIOs' effectiveness in improving the quality of health care."
Grassley and Baucus added, "We would like our staffs to discuss legislative and administrative changes necessary to ensure that QIOs improve the quality of health care for Medicare beneficiaries, use resources judiciously and adhere to ethical business practices."
Todd Ketch, AHQA's vice president for governmental affairs, said QIOs already are responding to the calls for reform, and 50 of 53 QIOs have adopted industry standards on board structure, compensation and perks. He added that AHQA has proposed to CMS administrative and legislative changes to improve QIO accountability" (CQ HealthBeat, 5/16).