Institute of Medicine Calls for Strengthening and Modernizing QIO Program
The Medicare QIO program was recognized as a “valuable resource to assist providers with quality improvement and performance measurement,” by the Institute of Medicine (IOM) in a March report to Congress. The second in a series of studies mandated by the Medicare Modernization Act, the report calls for strengthening and modernizing the QIO program and includes recommendations for QIOs to focus on providing needed technical assistance to health care providers, broadening QIO governance structures and improving management of the program by the U.S. Centers for Medicare & Medicaid Services (CMS).
IOM’s vision is that “QIO services should be available to all providers, Medicare Advantage organizations, and prescription drug plans.” IOM noted that QIOs have:
• “A strong foundation of quality improvement experts in each state;
• A network of collaborative relationships with providers and stakeholders;
• And a national infrastructure to support data collection, reporting, aggregation, and auditing, as well as research to further the development and use of quality measures.”
IOM’s Recommendations for QIO Program Improvement:
• Increase focus and funding for technical assistance to providers for performance measurement and quality improvement
• Remove QIO responsibility for case review, including handling beneficiary complaints and appeals, on the grounds that case review conflicts with provider collaboration in quality improvement efforts
• Ensure broader-based QIO governance, by making QIO boards more diverse and accountable to the public
• Increase competition for QIO contracts
• Improve management of the program
• Improve evaluation of effectiveness of QIO program
For a copy of the IOM Report, Medicare’s Quality Improvement Organization Program: Maximizing Potential, visit www.nap.edu. To read AHQA’s statement on the report, visit www.ahqa.org.
The American Health Quality Association, the QIO’s trade association, applauded the IOM review. Responding with support for the majority IOM recommendations, AHQA EVP David Shulke said, “The report is a strong endorsement of the value of the QIO program and its core work of quality improvement technical assistance.” AHQA is encouraging legislative and administrative changes to increase the scope and funding for the program.
A bipartisan group of members of the House Energy and Commerce Committee went on the record to agree in a letter suggesting Congress use the IOM report as an opportunity to strengthen the program saying, “It is imperative that QIO assistance…is available to as many providers and practitioners as possible.”
http://AHQA.newc.com/pub/uploads/Medicare_QIO_Program_Letter.pdf