This article was originally published in our December 2014 issue.
In 1965, President Lyndon Johnson signed a bill to make Medicare a part of Social Security coverage. The new bill went into effect July 1966 and expanded the 30-year-old Social Security program to provide hospital care, nursing home care, home nursing service and outpatient treatment for people over 65.
In 1972, Medicare Professional Standards Review Organizations began to oversee quality of care at the local level and, in 1982, became Peer Review Organizations (PROs) with new authority to protect Medicare beneficiaries from underuse of necessary health services.
A significant program milestone came in 1996 when PROs could systematically collect data, measure progress and identify areas for improvement. This allowed PROs to shift their focus from auditing of charts and following up on complaints to more targeted efforts. PROs began to focus on specific diseases and improving the management of common chronic conditions such as diabetes and cardiovascular disease.
In 2002, PROs were renamed Quality Improvement Organizations (QIOs) to reflect the multidisciplinary approach of all team members — physicians, nurses, and administration — working together to improve the quality of care. QIOs became the boots on the ground in communities, helping patients, families and providers carry out local activities that rolled up into national progress.
The QIO Program has achieved success in a number of areas, including reducing the incidence of pressure ulcers, the use of antipsychotic medications and unnecessary hospital readmissions. QIOs have played an important role in driving recognition of quality improvement. They also have provided technical assistance and tools, and shared best practices to achieve their overall goal of enhancing the quality of services delivered to Medicare beneficiaries.
In recent years, QIOs have also been able to establish strong partnerships and collaboration with stakeholders and patients, as well as each other. Learning and Action Networks (LANs) were developed in 2011 in an effort to bring together like-minded individuals around the achievement of a common goal. Around that time, the program also began to align its efforts with other health care agencies like the Agency for Healthcare Research and Quality, and the Centers for Disease Control and Prevention, as well as the private sector, to improve the health care system.
Today, the QIO Program is one of the largest federal programs dedicated to improving health quality at the community level. In August 2014, CMS established a new functional structure for the program that delivers value to patients and families, maximizes learning and collaboration for improving care, and supports the spread and sustainment of effective new practices and models of care. While the program continues to evolve, it remains focused on improving the quality of services delivered to Medicare beneficiaries.