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Investigators of care quality criticized for possible bias, lack of initiative

Ambulatory Safety Monitor, August 19, 2005

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Fueled by concerns that private contractors for Medicare are not fulfilling their responsibility to investigate patient complaints about quality of care, the chairman of the Senate Finance Committee is requesting information detailing the groups' operations, according to the Washington Post.

Sen. Charles E. Grassley (R-Iowa) has requested documents from 14 states about these contractors, known as Quality Improvement Organizations (QIOs). Grassley is taking action following recent Washington Post articles on the contractors and interviews by his staff with the groups.

In the Post's articles, the newspaper reports that QIOs, predominantly comprised of physicians, do not investigate many patient complaints and sometimes have a conflicted role in the investigations. The Post also found that if a complaint is filed and reviewed, a patient has a less that 1-in-4 chance of having their complaint confirmed.

The documents Grassley requested include the QIOs finance and policies for preventing the conflicts of interest. QIOs used to recommend hundreds of sanctions each year against physicians, but that number has dwindled to only a few, the Post reported.

Medicare pays QIOs $1.3 billion over three years to do a number of tasks including investigating complaints of quality of care received by Medicare patients, according to the Post.

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