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IOM Calls for Coordination of Federal Health Care Programs

Donna Young

The federal government—the most influential regulator and largest purchaser of health care services, spending over $512 billion annually—should take the lead to address serious quality-of-care and safety concerns confronting the nation, the Institute of Medicine (IOM) said in its most recent report on quality in health care.

Congress, IOM suggested, should direct the secretaries of the departments of Health and Human Services (HHS), Defense (DoD), and Veterans Affairs (VA) to work together to establish standardized performance measures and public reporting requirements for clinicians, institutions, and health plans participating in the government’s health care programs. Data collected by federal health care programs should be used to create reports comparing the quality of care among providers and, said IOM, those reports should be made readily available to the public—something that federal agencies have failed to make a firm commitment to in the past.

"The federal government should take full advantage of its influential position to set the quality standard for the entire health care sector," said Gilbert Omenn, a professor of internal medicine at the University of Michigan and chairman of the panel that prepared the report. Omenn spoke at a public briefing at the National Academies in Washington, D.C., on October 30.

About one third of Americans receive health services through Medicare, Medicaid, the State Children’s Health Insurance Program (SCHIP), DoD Tricare programs, the Veterans Health Administration, or the Indian Health Service, according to IOM’s report.

"The federal government should assume a strong leadership position in driving the health care sector to improve the safety and quality of health care services provided to the approximately 100 million beneficiaries of the six major government health care programs," the report said. "Given the leverage of the federal government, this leadership will result in improvements in the safety and quality of health care provided to all Americans."

The IOM report, Leadership by Example: Coordinating Government Roles in Improving Health Care Quality, is the third in a series requested by Congress.

The first report, To Err Is Human: Building a Safer Health System, released in 1999, raised public awareness about the large-scale occurrence of serious medical errors. Crossing the Quality Chasm: A New Health System for the 21st Century, a report released in 2001, suggested that the U.S. health care system is in need of major reform.

In its latest report, IOM suggested that the Quality Interagency Coordination (QuIC) task force—created in 1998 by the Clinton administration to coordinate public health care quality-improvement efforts—or some other interdepartmental structure, should play a pivotal role in implementing the six-year research agenda outlined in the report.

The report suggested that

  • The interdepartmental team declare standardized sets of performance measures for 15 leading health conditions by 2004,
  • The government require health care providers wishing to do business with federal health care programs to submit audited patient-level data necessary for the performance measurements by 2007,
  • Federal health care programs use higher-than-normal reimbursements or other incentives to recognize providers who adopt "best practices,"
  • The government strongly support the development of computerized clinical records, which providers and regulators need to adequately measure and improve the quality of care, and
  • Congress consider options, including tax credits, subsidized loans, and grants, to facilitate the rapid development of a national health information infrastructure.

The lack of computer-based clinical data for some federal programs, most notably Medicare, Medicaid, and SCHIP, Omenn said, "is a major impediment" to improving the quality of health care in the United States.

"This is the twenty-first century. Our quality-enhancement processes should not need to rely on culling information from paper medical records or claims forms to assess quality," he said.