ABOUT US
ABOUT QUALITY IMPROVEMENT ORGANIZATIONS (QIOs)
QIOs are required under Sections 1152-1154 of the Social Security Act to improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries. Based on this statutory charge, the core functions of the QIO Program are:
- Improving quality of care for beneficiaries;
- Protecting the integrity of the Medicare Trust Fund by ensuring that Medicare pays only for services and goods that are reasonable and necessary and that are provided in the most appropriate setting; and
- Protecting beneficiaries by expeditiously addressing individual complaints, such as beneficiary complaints; provider-based notice appeals; violations of the Emergency Medical Treatment and Labor Act (EMTALA); and other related responsibilities as articulated in QIO-related law.
QIOs are private contractor extensions of the Federal government that work under the auspices of the U.S. Centers for Medicare and Medicaid Services (CMS). CMS views the QIO Program as an important resource in its effort to improve quality and efficiency of care for Medicare beneficiaries.
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. QIOs are independent, 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. QIO contracts are 3 years in length, with each 3-year cycle referenced as an ordinal "SOW. QIOs are a nationwide community-based corps of experts dedicated to making health care safer and more effective in every state.
Throughout its history, the Program has been instrumental in advancing national efforts to motivate providers in improving quality, and in measuring and improving outcomes of quality. The main goal of QIOs is to accelerate the diffusion of evidence-based medicine into everyday clinical practice – in essence, to work with health care professionals in the community to ensure that patients get the best, most efficient, and safest care.
More information about QIOs may be obtained at http://www.cms.gov/QualityImprovementOrgs/.