Representatives Price, Kind, and Ross Introduce Bipartisan Legislation to
Restore QIO Program Structure Harmed in Trade Bill
Washington, D.C. – Representatives Tom Price (R-GA, 6th District), Ron Kind (D-WI-3rd District), and Mike Ross (D-AR, 4th District) have introduced legislation, the “Quality Improvement Organization Program Restoration Act” (H.R. 5942), to reverse damaging changes to the Medicare Quality Improvement Organization (QIO) program that were included as a $330 million funding offset for legislation (H.R. 2832) reauthorizing Trade Adjustment Assistance that was signed by the President in October 2011. The Quality Improvement Organization Program Restoration Act protects the health of Medicare beneficiaries across the nation by ensuring that the QIOs can continue working closely with providers under a long-standing program structure that focuses healthcare quality improvement resources at the community level.
“The QIOs have a commendable track record of working with local doctors to improve healthcare quality for Medicare beneficiaries. That’s why these organizations are key partners in the effort to improve healthcare quality and delivery,” said Price, a physician and member of the House GOP Doctors Caucus. “Any major changes that are considered to the QIO program should only be made after careful review and discussion, with input from physicians, the QIO community, and other stakeholders. Together we can ensure seniors have access to quality care that meets their needs.”
“We need to maintain the tools already available to help providers at the local level improve quality and lower costs,” Rep. Kind said. “Quality Improvement Organizations play an important role as partners working with local health care providers who are seeking ways to provide better care to their patients. Maintaining the established and trusted network of quality improvement organizations is more important now than ever.”
QIOs oppose provisions in the trade bill offset that eliminate the preference for state-based QIO contracts, instead allowing for regional or even national QIOs. According to Todd Ketch, Executive Director of the American Health Quality Association (AHQA), which represents QIOs, “Health care is local, as the individual needs of patients and providers are different in each state. State-based QIOs, and their relationships with the healthcare community within each state, are critical to ensuring the necessary focus and responsiveness to the varying and specific needs in every state,” said Ketch.
“It is important to keep professionals at the state level who provide immediate and direct attention to local beneficiaries, while also helping to lower long-term medical costs,” said Rep. Ross. “A shift of services from the state level could cause a delay and disruption in the current delivery of care to patients and could lead to the loss of hundreds of jobs. This legislation will help ensure that QIO programs will continue to be state-based, avoiding the negative impacts on Medicare beneficiaries and the economy at large as a result of regionalization or nationalization of the QIO program.”
QIOs also are concerned about changes in the law that allow for fragmentation of QIO functions, which could further strain providers and result in lost quality improvement opportunities. “Improving quality requires a comprehensive and integrated approach, and benefits from trusted and independent QIOs that have strong collaborative relationships with health care stakeholders across the continuum of care,” said AHQA President Jennifer Lundblad, PhD, MBA. Lundblad also is President and CEO of Bloomington, Minnesota-based Stratis Health, which holds the QIO contract for Minnesota.
QIO provisions in the trade bill enacted last year also remove the requirement for the important and long-standing role of local physicians in conducting peer review in states, taking the critical local perspective out of the review process. Moreover, the Secretary of the U.S. Department of Health and Human Services is given complete discretion to implement QIO program changes, without Congress ever having input.
Recognizing the importance of maintaining local physician involvement in QIOs, as well as keeping contracts state-based in scope, the American Medical Association’s (AMA) House of Delegates passed a resolution supporting efforts in Congress to reverse structural changes to the Medicare Quality Improvement Organization program at its 2011 Interim Meeting in November.
The Quality Improvement Organization Program Restoration Act would offset the cost of repealing the QIO provisions in the trade bill, according to a Congressional Budget Office score of the bill. This new legislation achieves savings by temporarily limiting QIO program funding with the proviso that at least 80 percent of the funds that are expended for the Center for Medicare & Medicaid Services’ QIO program are spent on core QIO contract functions.
The American Health Quality Association represents Quality Improvement Organizations (QIOs) and professionals working to improve the quality of health care in communities across America. QIOs share information about best practices with physicians, hospitals, nursing homes, home health agencies, and others. Working together with health care providers, QIOs identify opportunities and provide assistance for improvement. Learn more about AHQA at http://www.ahqa.org.