June 03,2009

Grassley works to improve Medicare quality with improved QIO system

Senator asks federal agency to explain why it relies on a substandard auditor of quality program

WASHINGTON --- Senator Grassley is asking the Centers for Medicare and Medicaid Services (CMS) to explain how it justifies using a government auditing firm that the Government Accountability Office has found to be “non-compliant” for its audits of the Quality Improvement Program, which is responsible for improving Medicare quality.

A report last summer of the Government Accountability Office (GAO), GAO-08-857, found that the contracted agency responsible for auditing the Quality Improvement Programs failed to be in compliance with acceptable government standards during its auditing of various Department of Defense contractors.

“There are documented problems with the QIO program and legislative reforms are needed to focus the program in an effective way. Until that gets done, CMS needs to do everything in its power to keep the QIO program on track,” Grassley said. “The fact that CMS is relying on a substandard auditor to review the QIO program is discouraging and calls into question the agency’s commitment to using the resources it has to improve Medicare quality.”

In 2007, Grassley introduced legislation to overhaul the QIO program. His bill, The Continuing the Advancement of Quality Improvement Act of 2007 (S.1947), would have required CMS to implement significant reforms to the QIO program to ensure that QIOs are effective and accountable in performing their responsibilities under the Medicare program. The reform initiative was based on Grassley’s own investigative findings, which included a QIO leasing residential properties and cars for board members and its CEO, and QIOs paying for conferences at lavish resorts.

The Inspector General for the Department of Health and Human Services also concluded in a 2007 report that quality concerns existed in the way that QIOs identified quality-of-care concerns throughout medical reviews and the interventions that QIOs took in response to the confirmed concerns.

Separately, the GAO issued a report in 2007 about the failure of QIOs to target adequately nursing homes providing poor quality care and the questionable effectiveness of QIOs to improve care in nursing homes that had received quality improvement technical assistance.

In addition, the Institute of Medicine of the National Academy of Sciences recommended in 2006, as required by legislation sponsored by Grassley, numerous changes to reform the QIO program.
Grassley said he hopes to have his reform measure considered as part of comprehensive health care reform.