Enhancing the Potential of Quality Improvement Organizations To Improve Quality of Care

Many agree that the quality of health care in the United States has improved in the past decade (1). Progress, however, has been slow, incremental, uneven, and far from what could have been realized with a more concerted effort, aligned incentives, improved performance measurement, wider adoption of electronic health records, and increased accountability (2). As the largest financial and programmatic sponsor of health care services in the United States, the Centers for Medicare & Medicaid Services (CMS) is responsible for leading the process of improving the quality of care for the nation's Medicare beneficiaries. Key components of this major responsibility are the Quality Improvement Organizations (QIOs), which contract with CMS to provide technical assistance and case reviews and investigate beneficiary complaints. These organizations have evolved over the past 40 years from an initial focus on hospital utilization review and identification of unnecessary care to a greater emphasis on measuring quality and outcomes of care and implementing interventions to promote quality improvement (3). Over time, the scope of these responsibilities has expanded beyond acute inpatient hospital care to include home health, skilled nursing facilities, and physician office practices. Health care provider involvement in the activities of the QIO Program is entirely voluntary.

A 1990 Institute of Medicine (IOM) report (3) called for the Health Care Financing Administration (now CMS) to systematically evaluate its efforts to improve the quality and outcome of care for Medicare beneficiaries. For the most part, CMS has not implemented this recommendation systematically, although it has made some largely isolated efforts to assess the QIO Program (4). The article by Rollow and colleagues in this issue (5) is …