Trade bill revamps QIO program, and quality advocates aren’t happy
Program being regionalized as a funding offset
Healthcare quality advocates say Medicare’s Quality Improvement Organization Program didn’t get a fair deal in both the substance and process of the U.S. trade bill Congress approved last week.
After approving trade agreements with South Korea, Colombia and Panama, the House of Representatives passed the bill reauthorizing the Trade Adjustment Assistance program, which helps U.S. workers who lose their jobs or work hours when trade deals shift production outside the country.
Included in the legislation were considerable policy changes to the Quality Improvement Organization Program that some say will compromise quality in favor of cost savings. The program changes were used as a funding offset for the worker assistance bill, and could—by Congressional Budget Office estimates—save about $300 million over 10 years.
The changes, which mirror legislation the Senate approved last month, would eliminate statewide QIO contracts in favor of ones that are regional or even national, a move the American Health Quality Association asserts will compromise the close working relationships QIOs have with providers and others in their local communities. The QIO provisions were introduced in President Barack Obama’s budget proposal in February, according to CMS officials.
The QIO program, established by a 1982 law, allows the CMS to contract with one QIO in every state, Washington, D.C., Puerto Rico and the U.S. Virgin Islands. A description from the CMS said these private organiza- tions—which are mostly not-for-profit—are staffed mostly by physicians and other clinicians trained to review medical care, help beneficiaries with complaints about the quality of care and implement quality improvements. The contracts last for a period of three years.
“The most troubling aspect that jumps to mind is this notion that the program might be regionalized or centralized,” said Jennifer Lundblad, president and CEO of Bloomington, Minn.-based Stratis Health, which maintains the QIO contract for the state of Minnesota. “The ability to do that for multiple states and not be based in the state where the work is occurring feels like a huge barrier and a huge disservice,” she said. “We can have national goals and national standards and national evidence. But healthcare is local.”
Another change would allow the CMS to award separate contracts for administrative case review and qualityimprovement functions within a contract area—again, on a regional or national basis. Lundblad said splitting up those functions would be contrary to the CMS’ push for more coordinated—and less fragmented—care. “So to break apart a quality infrastructure that is working on a continuum of care,” she said, “is counterintuitive to us.”
But Dr. Patrick Conway, chief medical officer in the CMS’ Office of Clinical Standards