Quality Improvement Organizations, which contract with the Centers for Medicare and Medicaid Services, need improved oversight of budgeting and spending because CMS lacks guidelines on how much data should be recorded during quality reviews, according to a Government Accountability Office report (.pdf) released publically Dec. 22, 2010 but dated Dec. 6, 2010.

The CMS uses volume and cost information provided by QIOs to establish quality of care review budgets, but "without consistent information on the volume and costs for quality of care reviews, CMS cannot ensure that the budget for these reviews...for each QIO is appropriate," the GAO report says.

For the most recent of the three-year QIO contracts--spanning Aug. 1, 2008 to July 31, 2011--CMS's budget totals about $1.1 billion. Of that, approximately $208 million has been budgeted for all types of reviews, including QIOs' quality of care reviews, reports the GAO.

The problem of QIO data collection is not new. A 2006 report by the Institute of Medicine and a 2008 internal report commissioned by CMS identified weaknesses in its "ability to accurately compare costs across QIOs."

In a 2008 CMS policy memo, the organization identified the different cost codes QIOs should use to record labor costs in the Financial Information and Vouchering System. But the memo fell short of specifying which quality of care review tasks should be recorded with each cost code.

For more:
- see the GAO report (.pdf)

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