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. QIOs also investigate complaints from Medicare beneficiaries. Recent investigations and studies conducted by the the Institute of Medicine and the Government Accountability Office have found that QIOs focus more on their work as consultants for health care providers than on investigations of complaints from 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. In addition, CMS would review QIOs based on consistent performance measures. QIOs that perform effectively would receive financial rewards, and those that perform ineffectively would receive financial penalties.