Often when you think of charities you think of organizations like American Red Cross or homeless shelters. Yet In the vast world of nonprofit organizations, there are entire industries that most people are unaware of. One of these is the $330 million industry of "quality improvement organizations," created by Congress to provide quality control and investigate complaints about health care. Every state has its QIO, and most of them are organized as nonprofits.
A few weeks ago, Sen. Charles Grassley has sent one of his letters to Mark McClellan, Administrator of the Centers for Medicare and Medicaid Services, complaining about some specific abuses in compensation and spending by the QIOs but also citing a report in the Journal of the American Medical Association that questioned whether QIOs were having any effect on health care quality. The comments were duly noted by the Washington Post.
One impetus for this questioning were an earlier series of reports by Gilbert M. Gaul in the Washington Post last summer: "Bad Practices Net Hospitals More Money," "Accreditors Blamed for Overlooking Problems," and "Once Health Regulators, Now Partners." The third article described how QIOs can make it difficult for patients to get access to medical records showing poor care, yet the QIOs themselves rarely punish doctors. In addition, the Post provided this chart showing the compensation of the executives of these organizations, with a good number in the $200,000+ range and one topping $500,000.
Now there is a book coming out from the Institute of Health, Medicare's Quality Improvement Organization Program: Maximizing Potential (2006). It can be read online for free, or the executive summary can be downloaded here.
The problems with QIOs are very similar to those of other charity organizations: difficulty measuring impact, high executive compensation, conflict of interest, and extremely slow pace of reform efforts.
And we saw earlier that these organizations also have the sense of entitlement of many charities, when we reported on the QIO chief that complained about getting billed for unauthorized use of his organization's 800 number, after AT&T had warned several times that the organization needed to improve its quality control.
