Medicare Quality Improvement Organizations (QIOs), contractors with CMS in each state, are the successors to the Peer Review Organization (PRO) program created in 1982 by Congress to monitor beneficiaries' quality of care and safeguard the integrity of the Medicare trust fund. In the early years, PROs conducted review work to ensure Medicare was paying for medically necessary care. Early quality efforts were limited largely to reviewing individual patients' care, a process known as case review. In the early 1990s, the Institute of Medicine conducted a major study of the program, and as a result, Medicare shifted the main focus of the program to proactive community-based quality improvement and beneficiary education. QIOs now work in partnership throughout the healthcare system with physicians, hospitals, nursing homes and home health agencies to help ensure the right care for every person every time.