The Centers for Medicare and Medicaid Services have unveiled a plan to consolidate state quality control groups into regional operations. The company that manages quality control of hospitals in Missouri says it’s a bad idea.
Primaris, based in Columbia, is a quality improvement organization that grew from a Congressional act in the 1980s. Chief Executive Officer Richard Royer says health … like politics … is local. Royer says he’s working with Missouri’s Congressional delegates in bringing the plan into Congressional hearings so members of Congress have a say in the plan. He says they’re concerned that the move is unilateral and not financially sound.
Royer says state-based models means local organizations can tailor programs to meet the unique needs of that state’s residents. For instance, one state may see more cases of obesity and need to focus on that, while another state may need to focus on the needs of cancer patients.
“Half of our delegation has signed on to co-sponsor legislation so that CMS would bring this entire plan into hearings so Congress has a say in it,” he says. “They’re very concerned that this is unilateral and not (based) on good financial plans. There is a bill in the House, HR 805, and four Missouri Congressmen have signed on as co-sponsors. That’s more than any other state.”
He says that measure would allow the consolidation plan or process to be actually “heard out.”
Primaris points to a recent study in the Journal of the American Medical Association, which found that QIOs were directly responsible for a drop in both hospitalizations and hospital readmissions. Primaris says the efforts of QIOs prevented about 6,800 hospitalizations and 1,800 re-hospitalizations per year, saving millions of dollars.
“These organizations address a big problem: as many as one in five Medicare patients return to the hospital within 30 days of being discharged, costing the Medicare program billions each year,” Primaris reports.
Primaris and other QIOs say having one regional organization cover three or four states will jeopardize patient safety and quality, pointing to the following reasons why:
1. A state-based approach allows local solutions to local care challenges. The state-based model means local organizations can tailor programs to meet the unique needs of state residents. One state may see more cases of obesity and need to address issues associated with that, while another state may need to focus on the needs of cancer patients.
2. If the federal government regionalizes its approach, an organization several states away without local staff can’t work as well with local hospitals, nursing homes and physicians.
AUDIO: Jessica Machetta reports (1:24)