Wednesday, July 27, 2005

Quality Improvement Organizations: Organized to Address Their Mission?

The Washington Post continued its series on Medicare with a story on Quality Improvement Organizations (QIOs). The story points out some legitimate policy questions about these organizations, particularly related to how their roles have changed as they evolved from "peer review organizations."
  • QIOs are apparently still tasked with collecting and addressing patient complaints. However, their current role is mainly to work collaboratively with physicians and hospitals on quality improvement projects. They have been accused of being slow and unresponsive in the face of such complaints, and the number of complaints seems inconsistent state to state. Although they have the power to sanction doctors and hospitals, they rarely do so. The boards of QIOs are made up almost entirely of physicians, but rarely include more than one consumer advocate per state.
  • Given that QIOs are tasked to do quality improvement projects, old rules that mandate a high level of secrecy about their work no longer clearly make sense. "These rules even prohibit them from publicly naming the hospitals they work with unless the facilities agree." Why "few do" is unclear. Specific QIOs said "the names and outcomes of their projects are private under their contract with Medicare."
But more in the Health Care Renewal bailiwick, the article revealed that QIOs now provide their leaders very generous remuneration. Forty-one of the state-wide QIOs provided their CEOs with more than $200,000 in total compensation, while eleven provided more than $300,000. The highest compensation, $519,084 pluse use of a BMW, went to Martin Margolies, CEO of PRONJ of New Jersey. Many of their boards are paid, even though in the larger not-for-profit world, board members are rarely paid. At best, such generous compensation may distract leaders from their primary mission.
Although the issues here don't seem as severe as many discussed on Health Care Renewal, many QIOs no longer seem organized to optimally address their mission.

1 comment:

james gaulte said...

And another related thing. My June 15, 2005 Retired Doc's Thoughts blog ( referenced a 6/15/2005 JAMA article that seemed to indicate that QICs do not increase quality measures.Never mind that, Congress has funded them for another several year period.