Got a Medicare complaint? Don't count on relief
Thu Mar 16, 6:39 AM ET
About $300 million of your federal tax dollars go each year to something called "quality improvement organizations." These are private groups in every state that are supposed to investigate complaints from Medicare patients and work with health providers to improve care. Yet it's highly questionable whether you're getting your money's worth.
Say you think doctors misdiagnosed a relative's condition. Even if you know where to complain to, you might never learn what went wrong, or why. Archaic laws prevent the organizations from telling you much of anything, unless your physicians grant permission.
Consider the case of David Shipp of Louisville, whose wife died of colon cancer in 1999. After a four-year battle, a federal judge ordered Health Care Excel, the organization that investigated Shipp's complaint, to reveal that his wife had received substandard care. But that's all he was able to learn.
The complaint process is badly broken. The Institute of Medicine, the government's health advisory body, and Sen. Chuck Grassley, the Iowa Republican who chairs the Senate Finance Committee, are calling for a major overhaul in the 25-year-old program. While Medicare administrator Mark McClellan acknowledges shortcomings, his agency has been slow to fix them.
Among the deficiencies:
• Low awareness. McClellan's agency does a poor job of informing patients of their rights. As a result, the private groups review about 2,500 complaints a year. That's about one for every 17,000 Medicare recipients.
• Weak sanctions. The quality improvement groups are loath to suggest punishing doctors. Only five health providers have been recommended for sanctions since 2003. Not surprisingly, the organizations are dominated by physicians and health executives.
• Lack of results. Hospitals that participate with the groups aren't any more likely to demonstrate improvements in quality than hospitals that don't, a study in the Journal of the American Medical Association found last June.
• No-bid contracts. Only six of the 53 contracts nationwide over the past three years were subject to competitive bidding.
• High living. Trustees of the groups have traveled to expensive resorts in Colorado Springs and Cape Cod for executive retreats, according to Grassley.
Quality Improvement Organizations do have potential to improve care by working directly with doctors and others, particularly in rural areas, to meet national standards.
To fix the system, Congress should allow the organizations to reveal to patients the results of investigations and to publicize performance records of health providers.
Permitting more patients to join the boards would send a message that patients are the client, not the health industry. And requiring competitive bids for contracts could also improve performance.
Americans spend more per person on health care than do people of any other developed country, including $294 billion this year on Medicare alone. What are we buying for all that money? It's time for serious answers, plus a guarantee that patients know that their complaints will be heard - and answered.
Copyright © 2006 USA TODAY, a division of Gannett Co. Inc.
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