We are pleased that Senators Grassley (R-IA) and Baucus (D-MT) introduced S.1947 (August 2, 2007), "Continuing the Advancement of Quality Improvement Act of 2007," said Judith Stein, Executive Director, Center for Medicare Advocacy. The bill creates a Medicare Provider Review organization (MPRO) to review the complaints of Medicare beneficiaries about the quality of care they receive. This is a significant departure from current law, notes Ms. Stein.

The bill takes the large and important step of requiring the MPRO to report all findings of its investigations, and actions taken, to the beneficiary, or a representative of the beneficiary, regardless of whether the findings involve a provider, practitioner or a plan. In creating this requirement, the bill provides that the findings of the MPRO may not be used in a tort claim or cause of action arising under state law, an important provider protection.

The bill removes from Quality Improvement Organizations (QIOs) the requirement that they review beneficiary complaints about quality of care. Under the bill, this function will reside solely with the MPRO. This means less money for the QIOs, Ms. Stein notes, but they will also have less to do. It will be "win-win" when the dust settles.

One big problem remains, according to Ms. Stein: defining the entities that have the expertise and capacity to perform the review functions of MPROs as the bill requires. "We are glad that the bill anticipates that MPROs will comprise diverse areas, disciplines, and expertise, including Medicare beneficiary and consumer groups," said Ms. Stein. "Interpreting and defining expertise in 'quality improvement and performance measurement,' the terms the bill uses, will be interesting and tricky, and we do not expect to see many new players on the scene", she concludes.