CMS QIO Progress Report Promotes Quality in Medicare Program
By - The Centers for Medicare & Medicaid Services’ (CMS) Quality Improvement Organization (QIO) Program published the 2014 QIO Progress Report.
The QIO Program is a leading federal program committed to ensuring Medicare beneficiaries consistently receive quality healthcare. As part of the US Department of Health and Human Services’ (HHS) National Quality Strategy for providing high quality and economically advantageous care, QIO maintains a solid mission “to improve the effectiveness, efficiency, economy, and quality of care delivered to Medicare beneficiaries.”
In August of 2014, CMS restructured its QIO Program to further enhance these objective. Five thousand nursing homes participate in the nationwide collaborative.
The QIO Program’s primary purposes include confirming Medicare only pays for reasonable and necessary services and goods within appropriate settings and assuring individual complaints from beneficiaries and that provider-based notice appeals are promptly addressed.
The QIO Progress Report discusses organization and administration changes, a summary of cost procedures, and an overview of future goals within the next five years.
Explanation of new QIO organizational changes
The structure of the new QIO Program adheres to a functional model with two types of QIOs – Quality Innovation Network-QIOs (QIN-QIOs) and Beneficiary and Family Centered Care-QIOs (BFCC-QIOs).
QIN-QIOs utilize outreach, education, successful sharing practices, and data measures while communicating and collaborating with community partners, patients, and families.
BFCC-QIOs provide efficient statutory review functions and maintain consistency within the case review process. In addition, they consider local factors and needs to improve quality of care, medical necessity, and the readmissions process.
Separating the complaint review process from quality improvement work emphasizes a commitment to promote improved population health and cheaper costs.
Two BFCC-QIOs manage complaints and appeals from beneficiaries to ensure fair management.
Fourteen regional QIN-QIOs work with providers, community partners, and beneficiaries on a variety of data-driven quality improvement initiatives. The objectives are to improve patient safety, lessen harm, engage patients and their families, improve clinical care, and decrease the volume of healthcare inconsistencies.
Highlights of QIN-QIO program’s five year goals
The QIN-QIO program’s efforts aim to increase the quality of care Medicare beneficiaries receive. QIN-QIOs will offer support for the twenty-seven percent of diabetic Medicare beneficiaries over age sixty-five via education. Additionally, QIN-QIOs aim to improve prevention coordination via automated tools for data extraction as established by the Meaningful Use program.
The QIO program also plans to establish partnerships with providers across a wide range of healthcare settings, federal agencies, colleges, and universities, to support and promote better coordinated care and pinpoint factors causing avoidable hospital admissions and readmissions.
Support and achievements for QIO progress
The 2014 QIO Progress Report illustrates a variety of supportive views regarding the aforementioned objectives and goals.
“It’s been really exciting to hear the number of lives saved, the costs savings, the reduction in avoidable events. And now, as we regionalize the program, we’re able to build on those successes and really accelerate things into the future,” says Sallie Cook, MD, Chief Medical Officer of Virginia Health Quality Center (VHQC). “We’re using the QIO Program and the many stakeholders it joins together to accelerate quality.”
Nursing home participants, according to the report, benefit greatly from the QIO Program.
The reported data demonstrates significant tangible efforts are succeeding. Potential adverse drug events were prevented in over forty-four thousand instances. Over three thousand pressure ulcers were prevented or healed within over seven hundred and eighty facilities. Over six thousand Medicare beneficiaries among almost one thousand facilities are restraint free. Additionally, there were over eighty-five thousand fewer days with urinary catheters for Medicare beneficiaries.
“These QIOs had passion and dedication, which was reflected in their data and success,” says Sue Fleck, CMS Health Disparities Program EDC Government Task Leader. “They had to be flexible to make this a high priority, in order to meet the needs of the beneficiaries, providers and communities.”
Additional nursing home goals to be implemented within the next five years are a resident-centered care and safety initiative and an ongoing effort to decrease the amount of antipsychotics use.
Says Patrick Conway, Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer, “CMS and QIOs are building momentum in transforming healthcare delivery by supporting learning systems, improving efficiency and value, and achieving better health outcomes for beneficiaries.”
One in five nursing home residents experiences preventable harm, according to a recent Inspector General report. This is one too many. Hopefully, future efforts will reduce this statistic and advance the quality of care Medicare beneficiaries receive within the next five years, and well beyond.
