There are 53 quality improvement organizations nationwide, with one in every state and territory. If CMS has its way, however, that number will drop dramatically over the next year. The government agency has proposed scaling back to as few as nine QIOs — which contract with CMS to monitor care provided to Medicare beneficiaries — and sharing resources across state lines. That approach would save about $300 million over 10 years, but some say the move will do more harm than good.

The American Health Care Association, the American Health Quality Association and others worry about the ill effects of not having a QIO in every state. The two groups sent out a joint press release on the issue last week, looking to drum up support for the cause, with a decision expected from CMS by early next year. Hospitals and providers have developed relationships with their local QIOs over the course of decades, and it would be tough to duplicate that bond with an organization that's miles away, says Todd Ketch, executive director of the AHQA, which represents QIOs nationally.

"We know that engaging in improvement activities in many ways is based on trust and your credibility in your communities," he says. "If providers don't know you, I think that sets up a much more difficult situation for you to be successful in engaging to improve care for those beneficiaries."

CMS is now considering four different options for how to disperse the QIOs, according to this breakdown, with plans to launch new contracts in August 2014. Those options include cutting the number of QIOs and basing them on the distribution of the national Medicare population, or going down to nine, tied to the current hospital referral regions. Things have changed a lot since CMS awarded its first set of contracts in all 50 states in 1984, according to this letter from the government agency requesting comment from the field back in May. Consolidation and a push for population health likely are factors.

"Since then, the field of health care quality improvement has blossomed tremendously," CMS writes. "The need for QIOs has evolved from utilization review alone to convening complex local communities that can span state boundaries, particularly as health delivery systems become more horizontally and vertically integrated and new alliances form."

Others, meanwhile, question whether it's essential to have a QIO in every state. Nancy Foster, vice president for quality and patient safety at the American Hospital Association, points out that there are plenty of opportunities for hospitals to work with other organizations to improve quality, such as Hospital Engagement Networks. She does, however, emphasize the need to preserve assistance for rural hospitals in submitting their quality data when moving to a more regional approach.

"We are not as convinced as other organizations that the current batch of quality improvement organizations are organized, on that state-based basis, in a way that makes the most sense," Foster says. "There are opportunities for hospitals to work with organizations that they trust, and that they feel offer them the most effective ideas for their quality improvement activities, and they may or may not be based in the state."

What do you think? Is sticking with the current state-based structure for QIOs most beneficial to hospitals, or would the industry be better served by a regional approach? Share your thoughts in the comment section below.