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June 14, 2005

Medicare’s Investment in Quality Improvement May Not Be Paying Off

Medicare’s quality improvement organizations are charged with improving the medical care of Medicare beneficiaries. A new study by researchers at the Johns Hopkins Bloomberg School of Public Health reports that hospitals that actively participate with these quality improvement organizations do not consistently show any greater improvement than hospitals that do not. The findings are published in the June 15, 2005, edition of the Journal of the American Medical Association (JAMA.)

“Medicare spends more than $200 million annually for the quality improvement organizations to improve the quality of care for its beneficiaries. Our study found that quality is improving regardless of involvement by the quality improvement organizations,” said Claire Snyder, PhD, a Health Policy and Management graduate of the Bloomberg School of Public Health. “This study raises important questions about the effectiveness of the quality improvement organizations.”

Snyder and Gerard Anderson, PhD, a professor in the Department of Health Policy and Management at the Bloomberg School, analyzed the medical records of over 43,000 Medicare beneficiaries from four quality improvement organizations representing five states and the District of Columbia. They measured improvements in 5 clinical areas—atrial fibrillation, acute myocardial infarction, heart failure, pneumonia and stroke—using 15 quality indicators specifically targeted by the quality improvement organizations. The data for the study were provided by the quality improvement organizations.

The researchers found no statistically significant differences in improvement over time on 14 of 15 quality indicators between hospitals participating with the quality improvement organizations and non-participating hospitals. Participating hospitals did show greater improvement in the screening and administering of pneumonia vaccination compared to non-participating hospitals. Of the 14 remaining, non-statistically significant indicators, the participating hospitals improved more on 8 indicators, while the non-participating hospitals improved more on 6 indicators.

According to Gerard Anderson, “The $200 million spent on the quality improvement organizations represents the federal government’s largest investment in quality improvement. A different approach may be needed.”

“Do Quality Improvement Organizations Improve the Quality of Hospital Care for Medicare Beneficiaries?” was written by Claire Snyder, PhD, and Gerard Anderson, PhD.

Support for the study was provided by grants from the Agency for Healthcare Research and Quality.

The authors acknowledge the assistance of Delmarva Foundation for Medical Care, Inc., Qualis Health, IPRO, HealthInsight and the Centers for Medicare and Medicaid Services (CMS) in providing data that made this research possible. The conclusions presented are solely those of the authors and do not represent those of Delmarva Foundation, Qualis Health, IPRO, HealthInsight or CMS. 

Public Affairs media contacts for the Johns Hopkins Bloomberg School of Public Health: Tim Parsons or Kenna Lowe at 410-955-6878 or