AMCNO Board Responds to Bill Introduced with Intent To Revise Medicare QIO System

AMCNO Board Responds to Bill Introduced with Intent To Revise Medicare QIO System
Max Baucus (D-Mont.) and Chuck Grassley (R-Iowa) have introduced a bill (S 1947) under which Medicare quality improvement organizations could not conduct investigations of beneficiary complaints about health care providers when they serve as consultants for those providers. The Center for Medicare and Medicaid Services pays about $300 million annually to contract with 53 QIOs -- organizations that operate in all 50 states to improve the quality of care provided to Medicare beneficiaries. The bill would establish new Medicare Provider Review Organizations to investigate complaints from beneficiaries. Under the legislation, CMS could contract with current QIOs to serve as MPROs, although not for the same states in which QIOs serve as consultants for health care providers. The bill also would allow other organizations to compete with current QIOs and would prohibit the renewal of noncompetitive contracts. AMCNO RESPONSE: The AMCNO has written to Northeastern Ohio Congressional Representatives and Senators outlining our concerns that a change in the review process as provided for in S1947 would “turn back the clock to the 1980s, when Medicare’s PROs responded to our members’ quality shortcomings with threats and sanctions, rather than assistance.” The AMCNO also noted in our letter that case review must be linked to quality of care assistance to physicians stating that most quality problems are best addressed by finding their root cause and changing the way care is provided, not by threatening regulatory action. The AMCNO agrees that medical review duties should remain within state QIO’s scope of work and should be performed by physicians who deliver patient care.