Study Questions Medicare's Quality Assurance Programs

Money paid to hospital oversight groups may not be producing results

TUESDAY, June 14, 2005 (HealthDayNews) -- Hospitals linked with quality improvement organizations (QIOs) -- Medicare-funded programs set up to monitor and help improve care -- did not improve their performance any more than hospitals not participating in this effort, researchers report.

"We found that quality is improving in hospitals regardless of involvement with QIOs," said lead researcher Claire Snyder, of the Johns Hopkins Bloomberg School of Public Health.

"Medicare is investing $200 million annually, and we think it's important that it produce value," she added.

The findings appear in the June 15 issue of the Journal of the American Medical Association.

Since its inception in 1965, Medicare has been concerned that beneficiaries receive appropriate and efficient medical care. To assure quality, the agency now contracts with QIOs to work with hospitals in improving performance by, among other things, providing educational materials and using data collection and feedback to track performance on quality indicators. QIOs also assist hospitals in making key systems changes.

To evaluate how successful QIOs have been, Claire Snyder and co-researcher Gerard Anderson looked at data from four QIOs that work to improve the quality of care in five states -- Maryland, Nevada, New York, Utah and Washington -- and the District of Columbia.

In their study, Snyder and Anderson analyzed data from the medical records of more than 40,000 Medicare beneficiaries diagnosed with one of five clinical problems: atrial fibrillation (a kind of irregular heart rhythm), heart attack, heart failure, pneumonia and stroke. They looked at 15 quality indicators associated with improved outcomes in the prevention or treatment of those problems, beginning in 1998 and again in 2000 to 2001.

The researchers found little correlation between hospital improvement and whether or not a hospital was participating with a QIO.

"At baseline, there were statistically significant differences between participating and nonparticipating hospitals on five of 15 quality indicators, with participating hospitals performing better on three of five," Snyder and Anderson wrote.

But over time there were no statistically significant differences noted on 14 of the 15 quality indicators, Snyder said. The only exception was that participating hospitals improved more on the pneumonia immunization indicator compared with nonparticipating hospitals, the researchers found.

Snyder noted that many organizations and hospitals themselves are working on improving quality of care, even though they are not availing themselves of QIOs. "There is a climate for quality improvement," she said.

The Institute of Medicine is currently evaluating the QIO program, Snyder said. "We hope this study will help inform their deliberations," she said. "Based on these findings, further evaluation of the QIOs program is needed, and potentially, some redesign is required."

The American Health Quality Association (AHQA), which represents QIOs, takes issue with these findings.

"She had a good idea," said David Schulke, AHQA's executive vice president. "But the data systems that were in place during that time didn't allow her to do the things we now can do."

Because of this, Schulke believes the study was looking at incomplete data which skewed the findings and didn't paint the full picture of QIOs today. "We will have data later this year from the Centers for Medicare and Medicaid Services that will solve those problems, and give people a much better sense of what's going on," he said.

Schulke believes that hospitals that work with QIOs do better than hospitals that don't. But institutions don't have to use a QIO to provide good quality care, he noted. "There are certainly hospitals that don't need QIO support. They are doing just great," he said.

"The QIO program has been successful," Schulke said. "It has helped hospitals." Schulke believes that the $200 million spent each year is money well spent. "It's a small amount of money," he said. "The QIO budget is less than 1 percent of Medicare spending, so it's a very small drop in a very large bucket."

More information

For more on Medicare, head to the Center for Medicare & Medicaid Services.

SOURCES: Claire Snyder, Ph.D., Johns Hopkins Bloomberg School of Public Health, Baltimore; David Schulke, executive vice president, American Health Quality Association, Washington, D.C.; June 15, 2005, Journal of the American Medical Association
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