Trade bill re­vamps QIO pro­gram, and qual­ity ad­vo­cates aren’t happy

Pro­gram be­ing re­gion­al­ized as a fund­ing off­set

Modern Healthcare - - CONTENT - Jes­sica Zig­mond

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

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