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What is the role and function of the Quality Improvement Organization program?

Quality Improvement Organizations (Q.I.O.s) are critical for Centers for Medicare amd Medicaid Services (CMS). The aim of Quality Improvement Organizations program is to enhance the quality, effectiveness, efficacy and economy of services offered to the beneficiaries of Medicare. In this regard, the fundamental functions of Quality Improvement Organizations are: improvement of quality of care provided for beneficiaries; maintaining the integrity of the Medicare Trust Fund entirety by making sure that only those goods and services that are important and needed and that are delivered in the relevant setting are paid by Medicare; and ensuring the protection of beneficiaries by effectively addressing the arising complaints (Colamery, 2003). Common complaints include individual beneficiary complaints and notice appeals of health care providers among others as indicated by law. It should be noted that CMS depend so much on QIOs program as stipulated by the Social Security Act, Sections 1152-1154 (King, 2010). In summary, Quality Improvement Organizations program is the regulator and link between Medicare beneficiaries and Medicare.

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b.   In your opinion, has the quality of health care received by Medicare beneficiaries improved or declined over time as a result of the QIO program? 

In my opinion, Quality Improvement Organizations program has contributed to the quality enhancement of health care received by Medicare beneficiaries. This is because all the health care providers are compelled by law to abide by the standards established by Quality Improvement Organizations program. Therefore; the quality of health care received by Medicare beneficiaries has increased significantly. Quality Improvement Organizations program has organized nationwide campaign for detecting and preventing fraud, waste, and abuse by health care providers which are under Medicare program. This program has been successful since it has reduced cases of fraud and improved the quality of health care services offered.

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