Once Health Regulators, Now Partners

The groups evolved in the 1980s into state-by-state Peer Review Organizations dominated by doctors, and eventually they were given responsibility for handling complaints from patients about poor care.

In the 1990s, responding to studies that found little evidence of the program's effectiveness, Medicare shifted the focus from weeding out bad doctors to broader efforts to improve care. It renamed the groups Quality Improvement Organizations.

Medicare's last three-year contract with the QIOs cost $1.15 billion, of which about $840 million went to the contractors and the rest to program overhead. The new contract is 10 percent more, nearly $1.3 billion.

Recently, researchers from Johns Hopkins Bloomberg School of Public Health raised questions about the QIOs' impact, noting that previous Medicare studies asserting wide improvements in quality included no control groups, making valid comparisons difficult. The researchers conducted their own study and concluded that hospitals working with QIOs were no more likely to show improvement than hospitals that did not take part.

The QIO trade group attacked the Johns Hopkins study, saying it relied on outdated information and flawed methods.

Schulke, the trade group's president, said QIOs are engaged in many successful activities to improve quality for Medicare patients. He cited projects to help hospitals both measure and improve care, reduce pressure sores in nursing homes and slash the number of surgical site infections.

The secrecy surrounding QIOs often makes it difficult for the public to assess their work. For example, in December 2004 many QIOs put out news releases touting that their work had led to improved nursing home care for Medicare patients.

One -- the Colorado Foundation for Medical Care -- said it could not provide a list of the 32 nursing homes that it worked with because the information was confidential. Other QIOs also said the names and outcomes of their projects are private under their contract with Medicare.

Rollow, of Medicare, said some of the agency's confidentiality rules "were developed a couple of decades ago and may in fact need to be reexamined." He expects the Institute of Medicine to take up the question as part of an ongoing study of QIOs requested by Congress.

In the meantime, some QIO executives say the current rules conflict with the groups' new mission. "We think it is critical for people to know who is . . . actually investing to improve," said Marc Bennett, president of HealthInsight, the QIO for Utah and Nevada.

A Hollow Court Victory

There are striking variations in the number of complaints that are investigated by QIOs from state to state, and in the chances of a complaint being upheld, according to reports examined by The Post.

Medicare patients in Massachusetts are nearly nine times as likely to lodge complaints as patients in Connecticut. The chance of a complaint being substantiated varied from 90 percent in Puerto Rico to none in Nebraska, Delaware, the District and the Virgin Islands, the analysis showed.