Fact Sheet
Legislation Modernizes QIO Program
AHQA Endorses Measure to Reform Beneficiary Complaint Process
Washington , DC — Legislation introduced today will strengthen and modernize the Medicare Quality Improvement Organization (QIO) program – the nation’s largest single federal investment in health care quality. The American Health Quality Association (AHQA) strongly supports the bill.
Introduced by U.S. Rep. Michael Burgess , MD (R-TX), the Medicare Quality Improvement Organization Modernization Act prepares the community-based QIO program to serve as an infrastructure for an all payer national strategy to improve health care and support federal transparency efforts. It will make the Medicare Quality Improvement Organization program more responsive to states and localities and allow more health care providers access to hands-on quality improvement assistance from QIOs. “All health professionals and their patients can benefit from QIO hands-on assistance, tools, and model practices that have been shown to improve the quality of care for Medicare beneficiaries,” said AHQA Executive Vice President David Schulke. “We urge Congress to adopt this legislation, so that all Americans can benefit from safer, more effective, and more efficient care.”
The bill includes many of the major reforms Rep. Burgess proposed in legislation introduced in July 2006 (H.R. 5866): making the beneficiary complaint process more responsive to complainants, ensuring the diversity and integrity of QIO governing bodies, and enhancing QIO program administration and evaluation.
Significant provisions of the Medicare Quality Improvement Organization Modernization Act include:
- Beneficiary complaint reform : making the complaint resolution process more transparent and accountable to beneficiaries and their families, while teaching providers proven methods for promptly resolving consumer concerns.
- QIO governance : ensuring that QIO governing bodies meet the highest standards for integrity, including expanded diversity, compensation rules, and consumer representation.
- Leveraging Medicare quality projects : allowing QIOs to provide technical assistance beyond the Medicare contract.
- Toughened competition and evaluation : increasing competition for QIO contracts and strengthening program design, management, and evaluation.
- Assuring adequate funding : limiting diversion of funding from work in the field and guaranteeing that increases in QIO work assignments are matched by adequate resources.
- Priorities that matter : ensuring local stakeholder and national expert input on priorities and measurable objectives for QIO work.
“We are very grateful to Dr. Burgess for his leadership in modernizing the QIO program. In the 25 years since most of the governing statute for the QIO program was written, we’ve learned a lot about our health care system and how to deliver better care,” said Schulke. “We’ve moved beyond the bad old days when the first response to all quality problems was regulatory action. We’ve learned to reserve punishment for the small number of negligent individuals who must be disciplined. Today, QIOs are measuring performance, computerizing medical practice, and helping professionals reorganize their work to reliably provide high quality care. Studies show the new approach works. The Burgess legislation builds on that success.”
The Centers for Medicare & Medicaid Services (CMS) administers the QIO program to ensure the quality care for Medicare beneficiaries. There is a QIO in every state and U.S. territory.
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, long-term care facilities, home health agencies, health plans, pharmacies, and employers to encourage the spread of best clinical practices and improve systems of care delivery. Visit: www.ahqa.org.
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