What are QIOs?

According to the CMS website, Quality Improvement Organizations (QIOs) are private, mostly not-for-profit organizations, which are staffed by professionals, mostly doctors and other health care professionals, who are trained to review medical care and help beneficiaries with complaints about the quality of care and to implement improvements in the quality of care available throughout the spectrum of care. CMS contracts with one organization in each state, as well as the District of Columbia, Puerto Rico, and the U.S.

According to the CMS website, Quality Improvement Organizations (QIOs) are private, mostly not-for-profit organizations, which are staffed by professionals, mostly doctors and other health care professionals, who are trained to review medical care and help beneficiaries with complaints about the quality of care and to implement improvements in the quality of care available throughout the spectrum of care. CMS contracts with one organization in each state, as well as the District of Columbia, Puerto Rico, and the U.S. Virgin Islands to serve as that state/jurisdiction’s QIO contractor.

QIO’s core functions include:

• Improving quality of care for beneficiaries;
• Ensuring that Medicare pays only for reasonable and necessary services and goods in the most appropriate setting; and
• Addressing individual complaints, such as beneficiary complaints; provider-based notice appeals; violations of the Emergency Medical Treatment and Labor Act (EMTALA) [EMTALA require hospitals and ambulance services to provide care to anyone needing emergency services.]
• On February 2, 2011, CMS published a proposed rule that would require most Medicare-participating providers and suppliers to give Medicare beneficiaries written notice about their right to contact a Medicare Quality Improvement Organization (QIO) with concerns about the quality of care they receive under the Medicare program.

Examples of work the QIOs perform includes:

• The Federal Doctor’s Office Quality Information Technology initiative (DOQ-IT).  This initative promotes the adoption of electronic health record systems and information technology in small-to-medium sized physician offices with a vision of enhancing access to patient information, decision support, and reference data, as well as improving patient-clinician communications.
• Surgical Care Improvement Project (SCIP). This hospital based quality improvement initiative led by CMS that focuses on reducing the rate of adverse outcomes of common surgical procedures..

History

According to Zeitler (2004), Peer Review Organizations (PROs)) were established through the Peer Review Improvement Act of 1982 (a part of the Tax Equity and Fiscal Responsibility Act of 1982), replacing Professional Standards Review Organizations (PSROs) that had been established in  1972. In FY2002, they were renamed Quality Improvement Organizations (QIOs).

There are 53 QIO contracts. QIO contracts are 3 years in length. The companies holding these contracts are listed below by state/territory:

• Alabama – AQAF
• Alaska – Mountain-Pacific Quality Health Foundation
• Arizona – Health Services Advisory Group
• Arkansas – Arkansas Foundation for Medical Care
• California – Health Services Advisory Group
• Colorado – Colorado Foundation for Medical Care
• Connecticut – Qualidigm [2]
• Delaware – Quality Insights of Delaware
• District of Columbia – Delmarva Foundation for Medical Care
• Florida – FMQAI [3]
• Georgia – Georgia Medical Care Foundation [4]
• Hawaii – Mountain-Pacific Quality Health Foundation
• Idaho – Qualis Health
• Illinois – Illinois Foundation for Quality Health Care
• Indiana – Health Care Excel
• Iowa – Iowa Foundation for Medical Care
• Kansas – Kansas Foundation for Medical Care, Inc.
• Kentucky – Health Care Excel
• Louisiana – Louisiana Health Care Review
• Maine – Northeast Health Care Quality Foundation
• Maryland – Delmarva Foundation for Medical Care
• Massachusetts – MassPRO
• Michigan – MPRO
• Minnesota – Stratis Health
• Mississippi – Information and Quality Healthcare
• Missouri – Primaris [5]
• Montana – Mountain-Pacific Quality Health Foundation
• Nebraska – CIMRO of Nebraska
• Nevada – HealthInsight
• New Hampshire – Northeast Health Care Quality Foundation
• New Jersey – Healthcare Quality Strategies, Inc.
• New Mexico – New Mexico Medical Review Association
• New York – IPRO
• North Carolina – The Carolinas Center for Medical Excellence
• North Dakota – North Dakota Health Care Review
• Ohio – Ohio KePRO
• Oklahoma – Oklahoma Foundation for Medical Quality
• Oregon – Acumentra Health
• Pennsylvania – Quality Insights of Pennsylvania
• Puerto Rico – Quality Improvement Professional Research Organization, Inc.
• Rhode Island – Quality Partners of Rhode Island
• South Carolina – The Carolinas Center for Medical Excellence
• South Dakota – South Dakota Foundation for Medical Care
• Tennessee – QSource
• Texas – TMF Health Quality Institute
• Utah – HealthInsight http://www.healthinsight.org/
• Vermont – Northeast Health Care Quality Foundation
• Virgin Islands – Virgin Islands Medical Institute
• Virginia – Virginia Health Quality Center
• Washington – Qualis Health
• West Virginia – WVMI Quality Insights
• Wisconsin – MetaStar
• Wyoming – Mountain-Pacific Quality Health Foundation