Medicare plans to improve quality and investigate complaints. The Institute of Medicine, said that Quality Improvement Organizations (QIO) which is responsible for attending to patient complaints has to be removed and this job has to be given to various other organizations. This is because QIOs have not effectively worked and have issued fewer provider sanctions in recent years. This could be because QIOs may not want to have conflicts with its providers with which it works.

Medicare pays 53 QIOs about $300 million a year to measure quality, work with hospitals and physicians to improve care, and to investigate patient complaints. A 283-page report was prepared which recommended the following alterations in the system. It called for sharply increased oversight and more competition, less secrecy in the QIO operations and major revision of the governance of the physician-dominated groups, such as putting more consumers on their boards and making public the compensation paid to directors.

The panel called on Medicare officials to conduct more rigorous and independent studies of the QIOs' work and make use of those results to guide future decisions about the program. A Washington Post investigation in July found that QIOs place a low priority on patient complaints, investigating just 3,100 complaints from Medicare beneficiaries in 2004. it was seen that lavish salaries and perks were being paid to some QIO executives and board members. Many of the QIO boards are dominated by physicians and have only a single consumer. They lack finance or audit committees, and a strategic planning committee.

Stephen M. Shortell, dean of the School of Public Health at the University of California at Berkeley and chairman of the panel said that they were frozen for some time while they were being upgraded. More nurses, pharmacists and consumers are included.