Grassley works to improve care for nursing home residents, reform federal oversight program

WASHINGTON — Sen. Chuck Grassley said today that a new report reveals additional shortcomings of a federal government system for monitoring the quality of care provided to Medicare beneficiaries, including residental care in nursing homes. He indicated that he will seek legislative reforms of the quality assurance program.

The independent Government Accountability Office reviewed the work of Quality Improvement Organizations, which are private contractors who work under the guidance of the Centers for Medicare and Medicaid Services. The study found that QIOs were generally able to meet modest targets set by the government for quality improvement in nursing homes, but the quality improvements couldn’t be attributed solely to QIOs, and that QIOs avoided the most troubled nursing homes when making choices about who to try to assist.

“Millions of older and disabled Americans have to rely on nursing home care,” Grassley said. “The QIOs are one of the government’s resources to monitor and improve the quality of that care. It’s a waste of that resource to have QIOs stay away from poor-performing nursing homes and fail to help the nursing home residents who are the most vulnerable to inadequate care.”

The Government Accountability Office report released today says that even when poorly performing nursing homes volunteered for QIO assistance, QIOs often chose homes that were less in need and would therefore be easier to assist. Eight QIOs excluded poor-performing nursing homes from assistance all together. The complete report – GAO-07-373 – is available at www.gao.gov.

Grassley requested this analysis by the Government Accountability Office as part of his inquiry into the activities and operations of QIOs that began in 2005. He is the Ranking Member of the Senate Committee on Finance, which is responsible for Medicare oversight and legislation. Grassley said the QIOs have a major responsibility to investigate complaints about poor care provided by doctors, hospitals and nursing homes under Medicare.

“The new report is more evidence that the QIO program needs an overhaul. It was
created to investigate and sanction health care providers for poor quality care. Today it’s got many different functions and some of those are at cross purposes. Medicare beneficiaries and taxpayers would be better served by a revamped program that focuses on providing quality-improvement services in a competitive environment and holds QIOs accountable for results.”

Grassley’s work to improve the quality of care in nursing homes began when he served as Chairman of the Senate Special Committee on Aging in the late 1990s. His oversight work at that time prompted the federal government’s present-day Nursing Home Quality Initiative.

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