Quality Improvement Organizations

Jefferson Government Relations, LLC (Jefferson) has had a long and fruitful relationship with Quality Improvement Organizations (QIO). We have represented individual QIOs as well as a national health quality organization. We also assist QIOs in maintaining a strong relationship with the Centers for Medicare and Medicaid Services (CMS, formerly HCFA), as well as addressing individual needs as the debate on health care and quality progresses.

As QIOs are brought into the health care debates (whether on patient safety, a Patient's Bill of Rights or changes to key federal programs such as Medicare or Medicaid), opportunities arise for solidifying QIO positions, as well as to enhance existing authority. We help identify what objectives need to be achieved, and assist policy makers in bringing about those changes in a way that is advantageous to our clients.

Jefferson's successes in this area include:

• On behalf of a consortium of health care QIOs and Peer Review Organizations (PROs), legislation in House and Senate was passed that created an independent external review mechanism in which QIOs would be a favored entity to determine the medical necessity of a health benefits denied by carriers.

The potential new revenue for QIOs exceeds $20 million annually.

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