Medicare Quality Improvement Organizations Rarely Implement Harshest Penalties, Report Finds

June 14, 2007 – 6:17 pm | posted in Medicare

Quality improvement organizations, which are responsible for improving the quality of care given to Medicare beneficiaries, have implemented the stiffest penalties in less than 2% of cases of quality-of-care concerns, according to a report released Friday by the HHS Office of Inspector General, CQ HealthBeat reports. QIOs review payment claims filed by physicians and hospitals to determine whether care is overly costly and whether services provided are reasonable and medically necessary. The organizations also identify cases of poor-quality care and help doctors develop techniques to improve performance.

The report, which was requested by Sen. Chuck Grassley (R-Iowa), found that QIOs reviewed 300,000 cases between Feb. 1, 2003, and Jan. 31, 2006. Eleven percent of the cases, or 34,768 cases, were reviewed in-depth for quality-of-care issues, and a significant quality-care concern was cited in 19% of those cases. According to the report, a “concern” indicates care that causes a “significant or potentially significant adverse effect on the patient.”

QIOs recommended corrective actions in 72% of cases with a confirmed quality concern but implemented the least severe corrective actions in 70% of those cases, the report found. Less than 2% of corrective actions included the harshest penalties, such as monetary fines, referrals to licensing boards or exclusion from Medicare, according to the report.

Popularity: 9% [?]

Share This

Also Read

Medicare Announces Measure Specifications For The Physician Quality Reporting Initiative, USA

CMS Reports To Congress On A Fully Bundled Medicare Payment System For ESRD, USA

Many State Medicaid Programs To Implement Pay-for-Performance Measures, Survey Finds

AP/Washington Times Examines Effects Of New Rule On Medicare Hospital Reimbursements For Preventable Conditions

Top Hospitals Have 28 Percent Lower Mortality Rate, Annual Study Finds

AHCA/NCAL Praises House Budget Blueprint That Protects Medicare & Medicaid Funding, USA

Massachusetts Hospitals Trying To Enroll Residents In State Subsidized Insurance Plans Find Many Don’t Know About Requirement To Purchase Health Ins.

Enforcement Options Considered For Proposed California Health Insurance Mandate

MedPAC Votes To Recommend Comparison Of Health Care Services

JAMA Commentary Discusses Patient-Centered Care; Study Examines Medicare Reimbursement’s Effect On Colonoscopy Rates;