Medicare Compliance & Reimbursement

Medicare QIOs have no significant impact on quality of care, JAMA says.

The American Healthcare Quality Association refuted a study on Medicare's quality improvement organizations, published in the June 15 Journal of the American Medical Association, arguing that the researchers used outdated information and created a "misimpression" of QIOs' current effects on patient-care quality.

Johns Hopkins Bloomberg School of Public Health researchers Claire Snyder and Gerard Anderson collected data from four QIOs enlisted to improve quality of care in Maryland, Nevada, New York, Utah, Washington and the District of Columbia. "Do Quality Improvement Organizations Improve the Quality of Hospital Care for Medicare Beneficiaries?" is a follow-up study that uses previous baseline data collected from hospitals prior to their involvement with the QIO program in 1998.

In each state, Snyder and Anderson used 750 Medicare beneficiaries' medical records to compare 15 quality indicators associated with five clinical areas in QIO-participating hospitals to non-participating hospitals. Study: No Quality Difference For QIO Facilities Follow-up data from 2000 to 2001 showed that participating hospitals had no changes in patient-care quality that significantly differed from quality changes in non-participating hospitals.

In fact, the only area that showed a statistically significant difference in changes was the pneumonia immunization indicator.

"Our study found that quality is improving regardless of involvement by the quality improvement organizations," Snyder said in a statement. The findings are troubling because Medicare spends more than $200 million each year on QIOs, the researchers noted.

AHQA Says Study Is Misleading, Outdated The AHQA took serious issue with the report's methods and data, however. The study's targeted time-period was well before the program was substantially revised, AHQA executive vice president David Schulke said in a statement released June 14.
 
"In 2002, the QIO program was refocused to take advantage of advances in quality improvement methodology developed by the Institute for Healthcare Improvement and other expert sources," he explained.
 
Furthermore, Schulke disputed the study's methodology, claiming that assessing QIOs' contributions during that time period is difficult. "Many hospitals in the study sample had been working with the QIO for only a short time, and some had not yet started working with the QIO at all," he argued.

Schulke wants JAMA to publish QIO data from 2002 to 2005, available later this year, to correct any misinterpretations relating to QIOs' effectiveness. He offered the Institute of Medicine's preliminary data for the current QIO work cycle.
 
"Hospitals working intensively with QIOs achieved greater improvement in nine out of 10 quality measures than did hospitals that received little or no QIO assistance," according to Schulke.