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Congress centralizes medical decision-making and threatens physician oversight

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Major changes to Medicare quality improvement tucked into trade legislation

Ron Ritchey, MD, MBA
Chief Medical Officer
eQHealth Solutions, The Medicare Quality Improvement Organization for Louisiana

Local level control and physician involvement in health care quality improvement in the U.S. was jeopardized by the passage of the Trade Adjustment Act of 2011 (HR 2832) through the House last week.

Changes to how Medicare Quality Improvement Organizations (QIOs) across the country operate were tucked into this legislation with no discussion from other members of Congress.

Removal of physician membership requirements. Currently, QIOs contracting with Medicare are required to enlist 20% of the practicing physicians in the state as members. In the new law, any organization competing for a QIO contract is only required to have one healthcare representative on its board.

Loss of state-level governance. Currently, Medicare QIOs are required to be state-based organizations. The new law allows regional or national companies to conduct quality improvement work and review. Centralizing medical decision-making could result in providers from Florida working remotely to improve quality in Louisiana for example.

These amendments threaten decades of quality gains and the safety of Medicare beneficiaries. As Louisiana’s QIO, the upward climb in health care quality in our state is a testament to our local providers’ commitment to working with us on continuous quality improvement. See a compilation of Louisiana provider accomplishments and national quality gains in CMS’ QIO Program Progress Report.

$300 million was cut from the Quality Improvement budget nationally to pay for the Trade bill — which we can live with. Louisiana’s QIO is no stranger to belt tightening and sustained a 37% cut in budget just this year. But we can’t live with a reform policy that takes quality improvement out of the hands of local providers.

At a time when we foresee reductions in Medicare, now more than ever, we need local practicing physicians to oversee the quality and accessibility of Medicare services.

You can help support the QIO program’s ongoing state-based focus. Soon there will be other healthcare-focused legislation that can be amended to fix what was broken in HR 2832.

Congressman Tom Price from Georgia, also a physician, is leading efforts in D.C. to have an open discussion about this issue. With three physicians currently serving in the U.S. House, Louisiana is helping to lead the way to influence a repair. But these changes affect every patient in the U.S.

With one short email you can ask your congressional representatives to consider meeting with Congressman Price to discuss how we can restore local level control and physician sponsorship to quality improvement. (Sample email message is below.)

Louisiana congressional representatives contact information is available here.

Not in Louisiana? Email Congressman Price’s legislative aide Laura Holland, who is on the Health Policy Committee, directly at laura.holland@mail.house.gov. You can also contact your state’s QIO or the American Healthcare Quality Association for more information.

Sample email messageI’m concerned about the removal of physician sponsorship requirements from Medicare Quality Improvement Organization contracts in HR 2832. I hope that you will call or meet with Congressman Tom Price from Georgia to discuss how local physician involvement can be reinstated.

Click Here to sign up for email updates on this issue.


Permanent link to this article: http://www.eqhssmarterhealthcare.org/congress-centralizes-medical-decision-making-and-threatens-physician-oversight/


  1. Anna-May Smith

    From where I sit the QIO’s are failing the Medicare beneficiaries. There needs to be more scrutiny and accountability. Often the QIO’s have questionable relationships with the very folks they are reviewing……… the patient suffers…….

    1. Isadora

      In 1994- 40% of U.S. doctors were in solo or small 2 pesron practices. In 2005 this went down to 32%. Most have joined up with other bigger practices or closed. I think most Doctors nowadays (most employed) – do not realized the impact of the public option to their salary – especailly since this will likely become single -payer in the future. Soon all will have to be employed. Is this a trend that inevitable anyways? When I asked my hospitalist collegues, they seem to think it will not affect them in anyway. (I was a hospitalist as well before). Sadly, We will all be affected one way or another – (you employer will demand more productivity since reimbursement will be less with the public option/single payer – and thus may cause further deterioration in you patient care quality, and as well as your own life. OR they will ask a pay cut on your salary.

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