EMBARGOED FOR RELEASE: 1PM ET
March 9, 2006
Contact: Richard Deutsch
Phone: 202-261-7573

AHQA Supports IOM Call for Strengthening Medicare Quality Improvement Program

Washington, D.C. – The American Health Quality Association (AHQA) today announced its support for most of the recommendations by the Institute of Medicine ( IOM) designed to modernize Medicare’s Quality Improvement Organization (QIO) program. After studying the QIO role in advancing quality of care for over a year, the IOM released its vision for the future of the program in a report to Congress today.

AHQA, representing the national network of QIOs, agrees with the conclusion of the IOM that “The Quality Improvement Organization (QIO) program must become an integral part of strategies for future performance measurement and improvement in the health care system.”

“This report is a strong endorsement of the value of the QIO program and its core work of quality improvement technical assistance,” said David Schulke, AHQA Executive Vice President.

Calling for better program management and funding, the IOM says that, “the committee believes the existence of 41 separate organizations holding QIO contracts dedicated to providing quality improvement services in every state, the District of Columbia, Puerto Rico and the Virgin Islands struck the committee as a significant asset.” The IOM’s vision is that “QIO services should be available to all providers, Medicare Advantage organizations, and prescription drug plans.”

Last week, a bipartisan group of members of Congress went on the record to agree in a letter suggesting Congress use the IOM report as an opportunity to strengthen the program (http://AHQA.newc.com/pub/uploads/Medicare_
QIO_Program_Letter.pdf). “QIOs are in the vanguard of efforts to reduce medical errors and improve quality, and the program is already making a substantial difference in how health care is delivered to all Americans,” wrote Dr. Michael Burgess (R-TX), and ten other members of the House Energy & Commerce Committee. “It is imperative that QIO assistance…is available to as many providers and practitioners as possible.”

Focus on Technical Assistance: AHQA concurs with IOM’s recommendation that face to face technical assistance for both performance measurement and quality improvement should be the focus of QIO efforts, and that Congress should remove CMS restrictions preventing QIOs from being retained directly by providers who want to purchase help to improve.

In its recommendations today, the IOM also called for narrowing the scope of the QIO program by ending QIO responsibility for handling beneficiary complaints and appeals. These efforts, however, bring QIOs in direct contact with Medicare beneficiaries and often provide invaluable opportunities to help providers improve care for all patients. AHQA earlier this week proposed comprehensive reforms of the beneficiary complaint program consistent with IOM’s focus on improving responsiveness and transparency for patients and assisting providers to establish safer, more effective clinical operations (AHQA’s recommendations are at www.ahqa.org).

Broader-based QIO Governance: The IOM report also calls on QIOs to make their boards more diverse and accountable to the public. AHQA supports this recommendation, noting that 30 of the nation’s 41 QIOs have already signed on to new code of conduct put forth by AHQA late last year that sets high standards for board and executive compensation, diversity, travel expenses, and conflict of interest (AHQA’s new policy is available at www.ahqa.org).

More Competition and Better Management: “AHQA welcomes the IOM’s call for more thoughtful program planning and management. We hope CMS will be more interested in these ideas now that they are coming from the IOM. Action has been stalled before this by a culture problem in which many CMS officials view QIOs as simply an extension of the CMS staff that should do as they’re told—rather than as the seasoned, pragmatic experts they are,” said Schulke.

Evidence of QIO Effectiveness: The report notes that strong research design is lacking not only in the CMS evaluation of the QIO program, but in quality improvement studies generally. The IOM advises building on the QIOs’ strengths. “The presence of organizations with trained experts dedicated to improving quality improvement services in every state is a significant asset at both the national and local levels….The committee believes the absence of QIOs would be a significant loss for emerging quality improvement efforts, and that if such a program did not exist, CMS would need to create one to fulfill its obligation to ensure that all beneficiaries receive high-quality health care.”

Funding: “Our biggest hurdle in accomplishing Medicare’s ambitious mission continues to be that funding lags behind the scope of the assignment,” Schulke stated. The IOM report asserts that the “budget for the [current QIO program] provides too little funding for the QIOs to accomplish the full range of mandated technical assistance while achieving transformational change.” Schulke said, “Funding for quality improvement has been a chronic problem, and is now only 35 cents per beneficiary per month.” According to the report, “[i]n 1990, the IOM determined that investment in the QIO program was inadequate to achieve set goals…Since then, the program has added more task areas, while funding has become a smaller percentage of the overall Medicare budget.”

The American Health Quality Association is dedicated to improving the safety and effectiveness of health care. AHQA represents the national network of Quality Improvement Organizations (QIOs) that work with hospitals, medical practices, health plans, long-term care facilities, home health agencies, and employers to encourage the spread of best clinical practices and improve systems of care delivery.