Washington Post Concludes Series on Medicare With Look At QIOs
The Washington Post on Tuesday published the last article in a three-part series on quality of care in Medicare. On Sunday, the Post looked at the relationship between Medicare spending and quality of care. The Post on Monday examined Medicare oversight and the program's relationship with the Joint Commission on the Accreditation of Healthcare Organizations.
On Tuesday, the final part in the series examined Medicare's Quality Improvement Organizations, a network of 53 private groups on which Medicare spends nearly $300 million annually. A summary of the conclusion of the series appears below.
- "Once Health Regulators, Now Partners": QIOs are charged with working with hospitals and physicians to improve patient care, investigating patient complaints and assessing quality. However, the businesses that serve as QIOs "sometimes play a conflicted and controversial role," and many "increasingly view themselves not as regulators but as partners of hospitals, nursing homes and doctors, working to improve care," the Post reports. Health care consumers "appear to play little, if any, role" on QIO boards, and some QIOs have "leveraged their positions to become highly profitable businesses, paying generous salaries and perks to executives and board members" -- about two-thirds of whom are physicians, according to the Post. Over the past two decades, QIO sanctions against hospitals and doctors have fallen from an average of 31 per year to an average of one per year. In 2003 and 2004, QIOs received an average of one complaint for every 14,000 beneficiaries -- a total of about 3,100 complaints each year -- and complaints were upheld in less than one in four cases, the Post reports. In addition, there are "striking variations" from state to state in the number of complaints and the likelihood of a complaint being upheld, with the percentage of complaints that are upheld ranging from zero to 90%. William Rollow, a physician who oversees the QIO program for Medicare, said he could not explain the variations, adding that the program's role is "more educational today than regulatory." Rollow agreed that the number of complaints appears small considering the increasing number of Medicare beneficiaries, and QIO spokespersons "acknowledge[d] that the complaint process is not as well-publicized as it could be," according to the Post. Rollow said QIOs "provide a very valuable service in return for the taxpayers' investment" (Gaul, Washington Post, 7/26).
Gilbert Gaul, a Washington Post staff writer and author of the Medicare series, is scheduled to answer questions in a Washingtonpost.com online chat Tuesday at 1 p.m. ET. A transcript of the discussion will be available online.This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.