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CMS Requires Quality Improvement Organizations (QIOs) to Be More Accountable

Maybe Medicare's Quality Improvement Organizations (QIOs) will soon get their own public performance rankings! The Medicare program is requiring QIOs to more closely scrutinize hospitals and nursing homes.  This news comes as the ninth contract of QIOs is under the gun from the Centers for Medicare and Medicaid Services (CMS).  Reaction has been mixed as to whether QIOs are making a positive impact on the healthcare facilities they investigate and the Medicare beneficiaries they serve.

Under this new Medicare contract, QIOs will be required to conduct 85% of their work involving specified quality measures with the 4,000 hospitals and nursing homes currently identified by CMS as needing to improve in those measures.  CMS has targeted these hospitals for improvement in their surgical-care measurements. The nursing homes on CMS' improvement list must improve pressure ulcer rates and reduce the use of physical restraints.

Hospital executives sounded dubious about the potential for this new Medicare contract to improve the usefulness of QIOs.  "It's unclear how the changes are going to strengthen the relationship between hospitals and QIOs," said Leigh Hamby, a physician, Executive Vice President and Chief Quality Officer for Atlanta-based Piedmont Healthcare.  Nursing home executives, however, sounded more positive.  In the past, the QIOs' focus on nursing homes varied from state to state based on the QIO's priorities, said Larry Minnix, President and CEO of the American Association of Homes and Services for the Aging.  "This ninth statement of work is going to make all of us work together," he added. 

Starting in August, more cross-facility collaboration between nursing homes and hospitals will be required to improve patients' transitions.  QIOs will actively speak to specific hospitals and nursing homes about how individual patients are being treated at each facility.

CMS developed the list of facilities as a response to criticism from the Institute of Medicine and the Government Accountability Office , both of which reported that Medicare was not efficiently managing QIOs, and that QIOs were not fulfilling contractual obligations to work with those healthcare facilities most in need of quality improvements.  The new statement of work will establish more stringent parameters to track QIOs' progress.  The 53 QIOs currently contracted by the Medicare program will be required to submit detailed, well-thought out proposals that show they understand what the CMS hopes to accomplish under the new contract in order to retain their designation, said H. John Keimig, President and CEO of Quality Partners of Rhode Island, that state's QIO.

This recent revamp of the QIO statement of work by officials at CMS demonstrates how the trend to reduce medical errors and improve healthcare outcomes is tightening performance expectations for healthcare facilities.  Medicare officials have recognized that new quality standards, accountability programs, and pay-for-performance incentives can only be effective if accurate measures and adequate resources exist to check performance against standards.  In other words, healthcare facilities that pass inspections are only as good as the inspectors that inspect them. That is why this latest contract between Medicare and the QIOs emphasized better measurement and closer interaction with the hospitals and nursing home facilities already identified as needing the most improvement.

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QIOs must show and prove:  CMS  (Modern Healthcare subscription required)