Questions? Call 888-624-8373

HARDBACK + PDF
your price: $70.50
add to cart

HARDBACK
list:$59.95
Web:$53.96
add to cart

PDF BOOK
your price: $46.00
add to cart

PDF CHAPTERS
your price: $3.50
select

Rights & Permissions

topleft topright

Medicare's Quality Improvement Organization Program: Maximizing Potential (Series: Pathways to Quality Health Care) (2006)
Board on Health Care Services (HCS)

Page
501
bottomleft bottomright
  E-mail
 Facebook
 Digg
 Stumble
 Twitter
More
Page
501

Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page 501
Index A American Medical Association, 286, 355 Annual Medical Services Review Reports, AARP, 201 288, 289­292 Access to care Assessment of Peer Review Organization current inequities, 20­21 program performance, 45, 136­137 Medicare goals, 39 Assessment of QIO program Accountability challenges, 36­39, 55­56, 58 for data collection, 14, 122 contextual factors, 38, 60, 61 National Quality Coordination Board, contract performance evaluations and, 84, 85 10, 76­77, 136 QIO boards, 71, 111, 132 cost-effectiveness evaluations, 17, 135 shared, 88 data sources for, 146­159 Activities of daily living, Medicare demonstrated competency, 52 population characteristics, 21 education and communications Acute care performance measures, 86 interventions, 283, 288 for physician offices, 394­395 funding decisions and, 139­140 AdvanceMed, 341 funding for, 17­18, 135 Advisory Council for Health Care Quality, goals of, 121 84 historical development, 34 Agency for Healthcare Research and home health technical assistance, 266­268 Quality, 39, 86, 91, 92, 98, 134, 148 Hospital Payment Monitoring Program, recommendations for, 16, 128 314­318 Ambulatory care performance measures, 86 hospital technical assistance, 268­269, Ambulatory care Quality Alliance, 65, 86, 286­287 103 identifying sources of improvement in American Association of Medical Colleges, quality of care, 5, 17, 57­59, 66, 79, 286 134, 137, 238­239 American Health Quality Association, 28, IOM methodology, 3­4, 27­29, 33, 38­ 147, 148, 149, 156, 251 39, 143, 145­159 American Hospital Association, 48, 286 levels of evaluation, 17, 134­137 501

OCR for page 502
502 INDEX nursing home technical assistance, 264­ member expertise and affiliations, 6, 266 166­168 performance classifications, 5, 357 member selection, 165, 169 physician practice technical assistance, participation in QIO evaluations, 136 269­271 performance evaluation, 13, 169 progress toward goals and, 135 recommendations for, 12­13, 110­112 protection functions, 310­311 size, 166 provider satisfaction, 273­275 standing committees, 6, 166 QIO board performance, 6 strategic planning role, 6, 72 QIO Support Centers evaluation, 246, term limits, 166 357 transparency of membership and recommendations for, 16­18, 134­138 operations, 6, 13, 71, 111­112, 190 research needs, 104­105 Breakthrough Series collaborative, 198, scope, 22­23, 38, 55, 137 246­247 selection bias in, 277 Breast cancer, 45, 48, 51. See also shortcomings, 4, 9­10, 277, 356­357, Mammography 359 Bronson Methodist Hospital, 240 study designs, 138, 145­146, 466­472 technical assistance performance, 257­ 272, 277 C See also Oversight of QIO program Assisting Providers in Developing the Cancer screening, 270. See also Mammography Capacity for Achieving Excellence, 192. See also Technical assistance Capability Enhancement Plan, 171 Asthma, 107, 396 Cardiovascular health, 44, 235. See also Heart failure; Myocardial infarction Atrial fibrillation, 236, 237 Award Fee Plan, 350 quality of care measures, 395 Case-control study designs, 467­468 Case Review Information System, 339 B Case reviews and appeals Annual Medical Services Review Baldrige criteria, 64, 162, 239­240 Reports, 288 Benefits Improvement and Protection Act, antidumping violations, 300 179­180 beneficiary satisfaction, 320 Best practices, 109, 177. See also BIPA reviews, 310 Knowledge transfer case management, 298, 308 Best Practices Methods Special Study, 248­ categories of case review, 300­301, 322 249 change in diagnostic-related group, 301 BIPA reviews, 115, 183, 310 CMS monitoring, 339 Boards, QIO conflict of interest restrictions, 73 accountability, 6, 71, 111, 132 contracting for, 8, 116 compensation, 13, 169, 190 cost-effectiveness, 8, 68­69, 116 conflict of interest restrictions, 7, 73 diagnostic-related group validation, 302 consumer representation, 6, 70, 110, early scope of work contracts, 41­42 165­166 fast track appeals, 300­301, 309 diversity of health expertise on, 71, 110­ historical development of Medicare 111, 190 quality assessment programs, 43, 50, financial oversight functions, 6, 72 297, 298, 322 functions, 165 hospital-issued notices of non-coverage, meeting frequency, 166 300, 303 member development and assessment, local circumstances and, 68, 161 71, 111

OCR for page 503
INDEX 503 notices of discharge and Medicare structure of QIO program in, 325­328 appeal rights, 300, 303 uses of QIO data, 123­124 organizational capacity for, 169­170 See also Oversight of QIO program; patterns and trends, 116 Quality Improvement Organization problem identification in, 116­117 program process, 298, 303­307 Certification in quality improvement, 64, provider perceptions, 68, 322­323 162 provider profiling activities, 307 Certified Professional in Healthcare Quality, QIO performance evaluation, 310­311 64 quality improvement and, 318­319 Chief executive officers' perceptions and quality reviews, 302 opinions range of outcomes, 305­308 of beneficiary education activities, 288­ recommendations for QIOs, 8­9, 13, 293 17­18, 112, 115­117, 138, 139 of case reviews, 68 referral sources, 298 of CMS data collection and processing, role of QIO, 7, 8, 68­69, 297, 298 343­345 sanctions, 307 of collaboratives, 198 types of reviews, 301­303. See also of contract recompetition, 346­347 Diagnostic­related coding groups; data collection, 151­154 Utilization reviews of Hospital Payment Monitoring utilization reviews, 302 Program, 321­322 See also Complaint investigation and knowledge transfers, 251 resolution organizational relationship concerns, Cataract surgery, 300, 323 355­356 Center for Healthcare Quality, 226­227 of public reporting, 283­285 Centers for Medicare and Medicaid Services of QIO Support Centers, 175­179, 247, (CMS), structure and functions 349­350 access to QIO data, 147, 154, 156, 172­ of recruitment of providers, 67, 107, 173 109­110, 195, 196 administrative office, 325 of staff, 64 Administrator's Quality Council, 78 Chronic illness Contracts Office, 325, 326­327 among Medicare beneficiaries, 2, 21, health care system relationships, 103 129 knowledge transfers to QIOs, 249 collaborative intervention for quality National Quality Coordination Board improvement, 243 and, 89, 90, 91, 93, 100 performance measures, 387, 388, 395­ national system for measurement and 397 performance and, 27 transitions in care, 2 Program Office, 325, 326 Claims data, recommendations for, 14, 121 QIO and End-Stage Renal Disease Clarification letters, 334 Steering Committee, 325­326 Clinical Data Abstraction Centers, 44, 125, QIO perceptions of, 326, 327, 330, 331, 184, 312, 341­343 332, 334, 336, 348 Clinical practice guidelines, 232­233 QIO performance evaluation Clinton Medical Clinic, 213 methodology, 466­472 CMS. See Centers for Medicare and quality improvement efforts, 2, 91­92, Medicaid Services, structure and 103 functions recommendations for, 11­17, 105­106, CMS Abstraction and Reporting Tool, 339­ 109, 110, 121­122, 126­128 341 regional offices, 327­328 Cochrane Database of Systematic Reviews, staff characteristics, 65 148

OCR for page 504
504 INDEX Collaboration Comprehensive measurement, 88 current practice in QIOs, 22, 64, 65 Conditions of Participation, 22, 107 Group Award Fee, 350 Confidentiality knowledge transfer and, 243, 246­247 beneficiary access to complaint leadership for, 198 outcomes, 124­125, 297 model for quality improvement, 240, data sharing restrictions, 7, 13­14, 74, 241­243, 252 121, 124­125, 188 national resource teams for, 133 in data submitted for QIO research, 149, pressures for competition, 60 158 recommendations for, 14, 106, 127 future challenges, 124 strategies for quality improvement, 35­ as obstacle to technical assistance, 173 36 public perceptions, 124 for technical assistance, one-on-one QIO performance evaluation and, 29, consulting vs., 197­198 74 Colorado Foundation for Medical Care, recommendations, 13­14, 121 133, 225­226 Conflict of interest restrictions Committee on Redesigning Health Insurance beneficiary protection and, 8, 73 Performance Measures, Payment, and on QIO contracting, 7, 73, 141, 171 Performance Improvement Programs, QIO data auditing and, 125­126 1, 19­20, 23­24, 27, 38, 145 rationale, 73, 171 Competition for QIO contracts, 345­347 recommendations, 18, 139 case review, 8 shortcomings of current system, 73, 141, diffusion of innovation and knowledge 171 and, 60, 245, 347. See also Consumer Advisory Council, 70, 169, 287, Knowledge transfer 288 NQCB implementation and, 94­96, 100 Consumer Assessment of Healthcare recommendations for, 15, 127 Providers and Systems, 86, 355, shortcomings of current system, 72­73 389 strategies for improving, 6, 131 Consumer Assessment of Health Plans Support Center contracts, 133 Survey, 185 See also Contracting Consumers and beneficiaries Complaint investigation and resolution access to QIO data, 124­125, 172 beneficiary perception and knowledge, 8, confidentiality of medical data, 124 114 data gathering for QIO program case review requirements, 300 evaluation, 156 complainant access to outcomes of, 297 intervention to increase awareness of contracting for, 13, 112, 113­114 rights, 8, 279 costs, 322 knowledge transfers, 250­251 data management, 14, 121, 124­125, perceptions of case review experiences, 297 320 historical development of QIO program, as primary client in complaint review, 8, 50 114 outcomes, 69, 319, 320 protection function of QIO. See Case patterns, 69, 113 reviews and appeals QIO role, 7 QIO board representation, 6, 12, 70, recommendations for QIOs, 13, 17­18, 110­111, 165­166, 168 112­115, 138, 139 QIO program evaluation methodology, role of QIO, 22, 297 28 shortcomings of current system, 8 quality improvement activities and, 40, volume, 319, 320 50, 108 See also Case reviews and appeals uses of QIO data, 123

OCR for page 505
INDEX 505 See also Complaint investigation and subcontracting, 52, 170­171 resolution; Educational and support contracts, 10, 16, 74, 77, 128, communication interventions; Public 184­185, 353, 357 reporting on performance See also Competition for QIO contracts; Continuous quality improvement, 44 Core contract; Scopes of work recommendations for QIO management, Cooperative Cardiovascular Project, 44, 16, 128 238, 248 Contract Officers, 16, 75, 128, 327 Coordination of care Contracting QIO strategic planning and, 9, 78 Award Fee Plan, 350 recommendations for QIO, 12, 106 for beneficiary protection activities, 8, See also Transitions, care in 13, 112, 113­114, 116, 139, 170 Core contract characteristics of contracting finances, 17­18, 69, 138­139, 180­183, organizations, 162, 190 190 clarification letters, 334 historical development, 46­47 CMS oversight, 326­327 length of, 15, 127 conflict of interest restrictions, 7, 18, 73, NQCB implementation and, 100 139, 141, 171 performance evaluation, 17, 134 contract management, 76, 131­132, performance periods, 15, 127 133­134 QIO oversight, 74 contract rounds, 265, 266, 268, 270, recommendations for, 14, 15­16, 126, 278, 348 127­128 current system, 21, 190 selection criteria, 15 for data collection and management, 96­ strategies for improving competition, 97, 341 94­95 demonstrated capacity for case review, subcontracting, 171 169­170 timetable, 15­16, 77, 128 funding allocation, 52, 69­70 Corporate Nursing Home Collaboratives, knowledge transfer considerations, 15, 133 127 Cost of care length of contracts, 11, 15, 77­78, 132, case review effects, 69 347, 349, 358 government spending, 62 noncompetitive renewal, 259, 260­261, historical development of Medicare 345­346, 358 quality assessment programs, 41, 42 NQCB implementation and, 90­91, 93­ Medicare spending, 2, 21, 129 96, 100 payment errors, 116 oversight of QIO activities, 10, 76­77, quality of care and, 20 345­347, 348­350, 356­357 Costs of QIO program and services physician-access or physician case reviews, 68­69, 116 sponsorship requirements, 110, 112, clinical data abstraction, 341­342 161­162 complaint investigation and resolution, policy direction and, 351­352 322 for program evaluation, 136 cost-effectiveness, 17, 135 QIO Support Centers, 16, 128, 133­ education and communications activities, 134, 349­350 288, 293 recommendations for, 14­16, 126, 127­ eighth SOW, 51, 179 128 funding, 17­18, 69­70, 138­141, 179­ special study solicitations, 183­184 180 staff characteristics of contracting Peer Review Organization program organizations, 163­164 budget, 43 strategies for improving, 131­132 program evaluation, 17

OCR for page 506
506 INDEX public reporting, 287 Delmarva Foundation for Medical Care, recommendations for, 17, 18 205, 224­225 special study and support contract Demographic variation in quality of care, 5, spending, 357 20­21, 57, 83 technical assistance, 62­63 Department of Health and Human Services, Crossover studies, 470 U.S., 19, 69, 286, 351­352 Crossing the Quality Chasm: A New Health confidentiality rules, 172 System for the 21st Century, 19­20 recommendations for, 11, 13­14, 17­18, Cultural Competency Organizational 105­106, 121­122, 134, 135, 138­ Assessment, 222­223 139 Depression, 107 quality of care measures, 396 D Diabetes, 5, 45, 48, 49, 107, 213, 216, 233, 235, 270, 271 Dashboard section of QIONet, 75, 154, quality of care measures, 395 262, 329, 337­338 Diagnostic-related coding groups Data collection monitoring, 312 accountability, 14, 122 review of changes in, 301 aggregation, 14, 97, 121 validation, 301, 302, 311 auditing, 97, 125­126 Diffusion of innovation theory, 244. See in care transitions, 129­130 also Knowledge transfer CMS activities, 341­343 Doctor's Office Quality­Information confidentiality issues, 7, 13­14, 74, 121, Technology, 52, 107, 184, 215, 343 124­125, 149, 158, 188 DynKePRO, 341 diagnostic-related group validation, 301, 302, 311 historical development of QIO program, E 49 home health agency outcomes, 205 Early adopters, 67, 107, 109­110, 194 infrastructure support, 26 Educational and communication oversight, 74, 75­76 interventions, 144 QIO program evaluation methodology, CEO perceptions of, 288­293 27­29, 33, 38­39, 146­159 consumer utilization of information sites, for quality improvement, 122­123 280­282, 295 real-time, 75, 89 current performance, 8, 295 recommendations for, 11, 13­14, 106, evaluation of QIO performance, 283, 288 121­126 funding, 293 scopes of work evolution, 44 goals, 279 staff and CEO interviews, 151­154, 155, historical development of Medicare 157 quality improvement programs, 39, technical assistance and, 7, 15, 96­97, 48, 50 106­107, 123, 130 importance of, 108 timeliness, 10, 122, 342­345, 358 nursing home interventions, 279­280 users of provider performance data, QIO spending, 288, 293 123­124 QIO Support Center activities, 177, validation activities, 14, 97, 122, 126 293­295 web-based, 149­150 QIO program, 7, 67 See also Information technology; recommendations for QIOs, 12, 106 Performance measurement scope of, 279­280, 287­288 Data Warehouse, QIO, 125 telephone help lines, 280, 287­288 Delirium interventions, 223­224 See also Public reporting on performance

OCR for page 507
INDEX 507 Effectiveness of care service delivery to underserved goals for health care system, 24 populations, 272 measurement challenges, 5 subcontracting in, 171­172 program evaluation, 17, 135 technical assistance evaluation Efficiency of care methodology, 259­264, 410­429 goals for health care system, 24 technical assistance in, 66, 70, 192, 200, measurement, 84 202­204, 208, 209­218, 220, 227­ Eighth SOW 228 Award Fee Plan, 350 transformational change goals, 352 beneficiary protection activities, 112, use of data from, for QIO program 309, 310­311 analysis, 28­29, 30, 146, 157­158 clinical data abstraction, 342 Electronic health records, 21, 26, 76, 107, collaboration incentives, 59­60, 64 120, 123 complexity, 76 Emergency Medical Treatment and Labor conflict of interest restrictions, 73 Act, 300, 301 contract competition, 72, 77 End-stage renal disease, 86 contract management, 77­78 quality of care measures, 395 contractor concerns, 352­353 End-Stage Renal Disease Networks, 22, 215 core contract, 182­183 Equitable care delayed release, 10, 77, 132, 351­352 goals for health care system, 24 deliverables, 430­433 measurement, 84 distinguishing features, 7­8, 51­52, 162 Evidence-based practice, 22 education and communication activities, Experimental Medical Care Review 67, 294­295 Organizations, 39 funding, 69, 70, 139, 179 home health agency technical assistance, 267­268 F Hospital Payment Monitoring Program, Failure rate, 193 315­318 hospital technical assistance, 269 Fast track appeals, 300­301, 309 improvement outcomes, 57­58 Federation of American Hospitals, 286 Fee-for-service contracts, 165­166, 311 information technology in, 107 knowledge transfer in, 130­131, 250 Feedback on provider performance, 14, 121, managed care organization technical 234, 236 Financial management assistance, 272 nursing home technical assistance, 265­ BIPA reviews, 183 266 conflict of interest restrictions, 18, 73, 139, 141 perceptions of CMS management in, 65 performance evaluation methodology, core contract finances, 180­183 259­261, 265­266, 267­268, 269, Hospital Payment Monitoring Program, 311, 320­321 270­271, 275­276, 277 population health initiatives, 98 improper payments in Medicare, 311­ private practice technical assistance, 312 non-CMS revenues for QIOs, 185­186 270­271 program evaluation findings, 18, 139 Peer Review Organization program program priorities in, 9, 129, 352 budget, 43 protection function of QIO, 7, 22 provider­QIO relationships, 113 provider satisfaction, 275­276 QIO board function, 72 public reporting requirements, 285 QIO spending and performance improvement, 265, 266, 268, 270, QIO Support Centers, 173­175 272, 278

OCR for page 508
508 INDEX QIO statewide investments, 137, 181­182 public reporting on performance, 50 special studies, 184 QIO effects on quality of care in, 57 support contracts, 184­185 QIO expenditures, 181, 182 support for program evaluations, 17, 135 quality of care measures, 387 See also Costs of QIO program and seventh SOW performance evaluation, services 404­405 Fistula First, 354 technical assistance to, 205­208, 224­ Florida Medical Quality Assurance, Inc., 225, 266­268 219 Home Health Compare, 86, 280 Formative evaluation, 45 Hospital Compare, 280, 286 Freedom of Information Act, 172 Hospital Payment Monitoring Program, 251 CEO perceptions, 321­322 CMS expenditures, 322 G effects, 320­321, 323 QIO performance evaluation, 314­318 Governance of QIOs. See Boards, QIO; QIO Support Center, 314 Management of QIOs; Oversight of reports, 312­314 QIO program role of, 50, 298, 311­312, 315 Government Task Leaders, 16, 76, 128, screening procedures, 312 133, 178­179, 246, 331­332, 355­ Hospital Quality Alliance, 65, 86, 103, 356 285­286 Grijalva reviews, 301, 310 Hospitals categories of case review, 300, 301 H critical access system hospitals, 212 eighth SOW performance evaluation, Health Care Excel, 205 418­423 Health care facilities, 161, 171 evidence of quality improvement, 57 Health Care Financing Administration, 43, notices of non-coverage, 300, 303 44­45, 48, 136­137 performance data, 341­343 Health Care Quality Improvement Initiative, prospective payment hospitals, 208­211 43, 44, 241 public reporting on performance, 50, Health Insurance Portability and 285­287 Accountability Act, 14, 74, 121 QIO effects on quality of care in, 57, Health Plan Employer Data and 236­238 Information Set, 86 QIO expenditures, 181, 182 Health Services Advisory Group, 202, 294­ quality of care measures, 389­393 295, 355 rural, 212­213 HealthShare, 97 seventh SOW performance evaluation, Healthy People 2010, 135 406­407 Healthy People 2010 Partnership for Heart technical assistance to, 208­213, 225­ Disease and Stroke, 226 226, 227, 268­269 Heart failure, 48, 49, 107, 225­226, 236, timeliness of CMS data collection, 344 237 Human factors model for quality quality of care measures, 392, 396 improvement, 240, 241 Hemodialysis, 51 Home health agencies eighth SOW performance evaluation, I 415­419 Identified participants, 192 evolution of quality improvement efforts, definition, 193 48, 49 in eighth SOW, 203­204, 210­212, performance data, 341 215, 227­228

OCR for page 509
INDEX 509 impact of QIO interventions with, 272­ J 273 recruitment, 193­197 Joint Commission on Accreditation of Immunizations, 49, 51, 98, 207, 213, 216, Healthcare Organizations, 39, 48, 268, 271, 354 50, 107, 286, 342, 355 Implicit review, 40 Improving Beneficiary Safety and Health Through Clinical Quality K Improvement, 192. See also Knowledge transfer Technical assistance barriers to, 60, 245, 347 Indian Health Service, 62 with beneficiaries, 250­251 Individual-level measurement, 88 CMS to QIO, 249 Infectious disease, 49, 225­226, 242 collaborative model for quality Information technology improvement and, 243, 246­247 for CMS public reporting function, 75­ conditions for, 244­245 76 definition and characteristics, 243 CMS systems and tools, 337­341 diffusion of innovation theory, 244 implementation resources, 107­108 early adopters as preferred recipients of infrastructure, 26 technical assistance and, 194 QIO oversight, 75­76 evidence base, 244­245, 252 QIO programs to promote, 52, 107 local circumstances and, 248­249 recommendations for, 12, 106 mechanisms, 59­60 support contracts, 185 participants and pathways, 243, 245 utilization by providers, 21, 26 payment incentives and, 244­245 Innovation, 86 QIO Support Centers in, 59, 134, 246­ diffusion of innovation theory, 247 244 QIO to provider, 249­250 early adopters as preferred recipients of QIO to QIO, 247­249, 251 technical assistance, 67, 107, 109­ recommendations for, 15, 16, 127, 128 110, 194 role in quality improvement, 243­244 QIO Support Centers and, 178 strategies for improving, 130­131 Institute for Clinical Systems Integration, technical assistance effects, 144 93 Institute for Healthcare Improvement, 93, 99, 198, 246­247, 354 L Institute of Medicine, 1, 3­4, 19, 22, 37, 42­43, 82, 136­137 Lean principles, 64, 240, 241 QIO performance analysis, 262­272, Leapfrog Group, 86 387­397 Literature review for QIO studies, 148­149 Insurance, health Local circumstances current population coverage, 21, 83 case review and, 40, 68, 161 in health care system quality knowledge transfer and, 130­131, 248­ improvement, 25 249 reform goals, 24 National Quality Coordination Board International comparison, quality of care, and, 86 21 QIO Support Center sensitivity to, 177 International Standards Organization 9000, technical assistance projects and, 198­ 64, 240, 241 199, 227 Iowa Foundation for Medical Care, 226, Long-term care performance measures, 86, 294, 336, 337 397 Longitudinal measurement, 88, 124 Lumetra, 223, 226, 227, 308­309

OCR for page 510
510 INDEX M quality assessment activities, historical evolution of, 35­36, 37, 39­48 Mammography, 5, 49, 213, 216, 271 quality improvement efforts, 103 Managed care organizations quality of care trends, 102 categories of case review, 300­301 spending, 2, 21, 129 current quality of care, 5 telephone help lines, 280, 287­288, 295 notices of discharge and Medicare Medicare, Medicaid, and SCHIP Benefits appeal rights, 300 Improvement and Protection Act, peer review organization and, 41 115, 182­183, 310 QIO board representation, 165­166 Medicare + Choice/Medicare Advantage, 11, quality improvement in, 57 40, 41, 52, 66, 69, 106, 215, 217, quality of care case reviews, 302 223, 272 technical assistance to, 221­223, 272 fast track appeals, 300­301 Management of QIOs QIO Support Center, 227 familiarity with quality improvement seventh SOW performance evaluation, methodologies, 64, 241 408­409 leadership qualities, 164­165 Medicare Payment Advisory Commission, 38 National Quality Coordination Board Medicare Peer Review Organization and, 90­100 Evaluation Plan, 44­45 program priorities, 9, 14, 36, 129, 199­ Medicare Prescription Drug, Improvement, 200, 352, 358 and Modernization Act (2003), 1, 19, quality improvement outcomes and, 59 23, 66, 83, 94, 115, 215, 221, 286, scopes of work revisions and, 134 342 strategic planning, 9, 72, 74, 78­79 Medicare Quality Improvement See also Boards, QIO; Chief executive Community, 174, 249, 294, 335­336 officers' perceptions and opinions Medicare Trust Funds, 40, 52 Mediation, 114, 297, 320 QIO funding, 69 historical development of QIO program, role of Hospital Payment Monitoring 50 Program, 50, 298, 311 indicators for, 307­308 role of QIO program, 7, 22 Medicaid, 25, 39, 62, 91 MedQIC. See Medicare Quality Medical Care Evaluation Studies, 40 Improvement Community Medical chart abstraction Memos and letters, 334 assessment, 116 MetaStar, 202 auditing, 125­126 Myocardial infarction, 5, 45, 48, 49, 225­ costs, 342 226, 236, 237 data sharing, 13­14, 121 quality of care measures, 391­392 future of, 76 See also Clinical Data Abstraction Centers N Medicare, 62, 91 beneficiary characteristics, 2, 21, 129 National Center for Health Services categories of case review, 300 Research, 39 coverage, 21 National Committee for Quality Assurance, evidence of quality improvement, 56­61, 50, 86, 355 79 National Healthcare Quality Report, 135 in health care system quality National Nursing Home Collaborative, 202 improvement, 24­25 National Quality Coordination Board hospital-issued notices of non-coverage, (NQCB) 300 accountability functions, 85 patterns and trends in quality of care, authorities and responsibilities, 85, 86, 4­5 89­90

OCR for page 511
INDEX 511 CMS and, 89, 90, 93, 100 technical assistance to, 201­204, 223, contracting authority, 90­91 264­266 data collection and management activities, 96­97 functions, 26­27 O goals, 85 health care system monitoring function, Office of Management and Budget, 69, 351­352 90 independence, 85 Oklahoma Foundation for Medical Quality, infrastructure support, 26 213, 225­226 Omnibus Budget Reconciliation Act, 41­42 membership, 85 population health promotion, 98 On-call physicians, 8 private sector relationships, 93 Osteoporosis quality of care measures, 396­ 397 public reporting activities, 98 QIOs and, 25­27, 90­100, 104 Outcome and Assessment Information Set, quality improvement function, 103­104 205, 207, 224 Outcome-Based Quality Improvement, 205, quality improvement program management, 92 207, 224 recommendation for, 84­85 Oversight of QIO program, 34, 74­79, 120, 135­136, 144 research agenda, 90 stakeholder relationships, 85 access to QIO data, 125 starter set of performance measures, 86 CMS personnel, 329­333 communications, 16, 75, 128, 333­336, structure, 92 system performance evaluations, 99 355, 358 National Quality Forum, 50, 286, 355 contracting activities, 10, 11, 74, 76­78, 345­347, 348­350 National resource teams, 133 National Surgical Infection Prevention criteria for quality measures, 354­355 Collaborative, 209, 241 current system, 9­11 data flow, 10, 74, 75­76, 341­343, 358 Nonequivalent control group study design, 469­470 data lag issues, 342­345 Notices of discharge and Medicare appeal identification of staff roles and responsibilities, 16, 128 rights, 300, 303 Nursing Home Compare, 86, 280, 282 information and communications Nursing Home Quality Initiative, 50 technology, 337­341 opportunities for improvement, 9­11 Nursing homes, 48, 49 data collection, 344 organizational relations, 355­356 educational and communication organizational structure, 325­328, 358 policy formulation, 351­353 interventions, 279­280 eighth SOW performance evaluation, program coordination, 16, 128, 353­ 410­415 356, 358 program guidance functions, 351 Medicare telephone help line, 280­282 performance data, 341 QIO performance evaluation public reporting on performance, 50, methodology, 257­261, 277 recommendations for, 14­16, 126­128 283­285 QIO effects on quality of care in, 57, shortcomings in overall program 264­266 evaluations, 9­10, 356­357, 359 site visits, 347­348 QIO expenditures, 181­182 quality of care in, 21 special studies, 183­184 quality of care measures, 201, 387 strategic planning, 9, 74, 78­79, 351 support contract management, 185 seventh SOW performance evaluation, 404­405

OCR for page 512
512 INDEX P Pharmacotherapy coordination of care, 9 Pain management, 49, 205­206 risks, 2, 21 Part D prescription drug benefit, 9, 19, 22, See also Part D prescription drug benefit 52, 78­79, 129, 217­218, 271 Physician Consortium for Performance eighth SOW performance evaluation, Improvement, 93 428­429 Physician offices and practices Pathways to Quality Health Care series, ix, data collection, 343 xi, 20, 33 eighth SOW performance evaluation, Patient-centered care 424­425 goals for health care system, 1, 24 QIO Support Center, 226 measures of, 84 quality of care measures, 394­397 QIO quality improvement activities and, seventh SOW performance evaluation, 108 406­407 Patient Safety and Quality Improvement technical assistance to, 213­218, 227, Act, 103 269­271 Pay-for-performance system, 38, 60, 63, timeliness of CMS data collection, 344­ 195 345 Payment Error Prevention Program, 48 Pilot programs, 248, 353 Payment incentives, 20, 25, 26, 33, 62, 82, Plan, Do, Study, Act Cycle, 44, 240 103, 244­245 Pneumonia, 48, 49, 235, 236, 237 PDSA Cycle. See Plan, Do, Study, Act Cycle quality of care measures, 392­393 Peer Review Improvement Act, 40, 70, 160 Population-based measurement, 88 Peer Review Organizations, 37, 40­41, 42­ Population health promotion 45, 48, 68, 136­137, 160 data collection, 14, 121 Performance measurement QIO role, 98 confidentiality, 124 Preventive care crosscutting measures, 398 quality of care measures, 394 goals, 83­84 Primaris, 294 historical development of QIO program, Private sector 50 contracting with local QIOs, 141 implementation of national system, 76, in health care system quality 89, 90, 106­108 improvement, 25 leadership for development of, 24­25, National Quality Coordination Board 84 and, 93 levels of, 87­89 organizations with quality improvement QIO funding and, 140 services, 99­100, 104, 435­436 recommendations for national system, Processes of care measurement, 84, 232­ 20, 26, 33 233, 235 recommendations for QIO, 11, 14, 17, Professional Standards Review 105­109, 121, 134­135, 138 Organizations, 40 standardization, 83­84, 86 Program Activity Reporting Tool, 338­339 users of QIO data, 123­124 Program for Evaluating Payment Pattern See also Assessment of QIO programs; Electronic Reports (PEPPER), 312 National Quality Coordination Project Officers, 16, 65, 75, 77, 128, 328, Board; Public reporting on 329­330 performance Prospective payment system, 41 Performance Measurement: Accelerating Protection function of QIO, 7, 22, 30, 52, Improvement, 20, 25­27, 29, 33, 34, 144, 297 62, 82, 83­92 confidentiality of clinical data, 74, 124­ Performance planning, 171 125

OCR for page 513
INDEX 513 historical development, 48, 50 Public reporting on performance provider perception, 68, 318 CEO perceptions, 283­285 QIO performance evaluation, 310 complexity of presentation, 283­285 in QIO Support Centers, 308­309 current practice, 103 spending, 322 current QIO data collection and, 106­107 strategies for improving, 8 data management demands, 75­76 See also Case reviews and appeals; hospital data, 50, 285­287 Hospital Payment Monitoring leadership for development of, 84 Program; Medicare Trust Funds national system, 20, 89 Providers of care National Quality Coordination Board barriers to knowledge transfer, 245 activities, 27, 98 in case review process, 305­306 pressures for competition among QIOs case reviewers, 303, 305 and, 60 cataract surgery assistants, 300 QIO and, 6, 11, 14, 18, 25­26 conflict of interest restrictions, 73 QIO spending, 287 data access restriction, 124­125 quality improvement and, 52­53, 83, data collection needs, 123 285 information technology, 21, 26 in seventh SOW, 50 Medicare quality improvement shortcomings of current system, 83 initiatives, 22 Standard Data Processing System and, 10 on-call physicians, 8 timeliness of data collection for, 122 Peer Review Organization relationships, 41, 42­43 perceptions of QIO protection function, Q 68 QIONet, 28, 75, 124, 154, 249, 336 performance data reporting requirements, 89 Qualis Health, 202, 246­247, 293­294 performance improvement and Quality Assurance in Medicare, 136 Quality Chasm series, 1, 19­20, 37­38, 83 satisfaction with QIOs, 265, 266, 268, 270, 272 Quality Coordination Team, 353­354 physician-access or physician Quality Council, 353­354 QIO program sponsorship requirements for QIOs, 12, 72, 110, 112, 161­162 funding, 17­18, 69­70, 73, 138­141, QIO board membership, 6, 12, 70, 71, 179­180, 186­187, 190 historical development, 34, 36, 37, 48­ 110­111, 167, 168 QIO knowledge transfers to, 249­250 51, 56, 160 QIO relationships, 3, 6, 8, 36, 56, 65, National Quality Coordination Board and, 25­27, 90­100, 104 67, 68, 112­113, 125­126, 318 QIO resource allocation, 12 non-CMS services, 185­186 readiness for change, 194 physician-access or physician sponsorship requirements, 72, 110, recruitment to QIO improvement projects, 67, 107, 109­110, 193­197, 112, 161­162 227 provider and stakeholder relationships, 3, 6, 8, 36, 56, 65, 67, 68, 112­113, relationships within health care system, 24 125­126, 318, 355­356 satisfaction with QIOs, 273­275, 278 quality improvement outcomes, 56­61, 66, 79, 104­105, 230, 234­239, 252, settings for QIO technical assistance, 66 uses of QIO data, 123 276­278 workforce retention, 51­52 recommendations for, 3, 11­18, 29, 33, 34, 102, 105­106, 110­111, 112, See also Performance measurement; Physician offices and practices; 121­122, 126­128, 134­135, 138­ Technical assistance 139

OCR for page 514
514 INDEX structure and functions, 1, 2­3, 6­7, 21­ R 22, 36, 51­53, 66­74, 104, 125­126, 143, 160­169, 188, 325­328 Race/ethnicity, quality of care and, 5, 21, See also Assessment of QIO programs; 57, 83 Oversight of QIO program; Support Randomized controlled trials for program Centers, QIO evaluation, 17, 59, 135, 138, 231, QIO Support Centers. See Support centers, 468­469 QIO Redesigning health insurance, 19, 20, 24 Quality Improvement Roadmap, 24, 78, Regional Offices, CMS, 327­328, 334­335 354 Regional variation Quality of care in hospital performance improvement, clinical conceptualization, 37­38, 52­53 268 current system, 2, 4­5, 20­21, 83, 102­ in performance improvement, 266, 278 103, 107 in physician office performance goals for health care system, 24­25, 37­ improvement, 270 38 in quality of care, 5, 20­21, 57, 83, 236 identifying causes of improvement in, 5, Reporting Hospital Quality Data for Annual 17, 57­59, 66, 79, 134, 137, 238­239 Payment Update, 285, 286 impact of case review activities, 318­319 Research international comparison, 21 distribution of special study findings, literature review for QIO studies, 148­ 184 149, 364­386 literature review for QIO studies, 148­ measure design and selection, 354­355 149, 364­386 organizational readiness for change, 234 National Quality Coordination Board performance measurement and, 24­25, role, 90 83, 84 provider receptivity to quality private sector organizations with quality improvement, 110 improvement services, 99­100 QIO effectiveness in quality process measures, 232­233, 235 improvement, 104­105 public reporting on performance and, Robert Wood Johnson University Hospital, 52­53 239­240 QIO effects, 5, 48­49, 56­61, 63­65, Root-cause analysis, 11, 106, 240­241 66, 79, 104­105, 137, 230, 234­239, Rural areas, 49, 64, 161 252, 276­278 seventh SOW performance evaluation, Quality Coordination Team, 353­354 408­409 quality improvement interventions, QIO technical assistance projects, 212­213, and non-QIO, 230­234 218­220, 271­272 rationale for government intervention to improve, 61­62 recommendations for improving QIO S contribution to, 11, 109­110 Saint Luke's Hospital, 239 relationship components, 38 Sanctions, complaint-related, 69, 113, 307 role of QIO program, 2­3, 7, 22 Scientific Officers, 16, 65, 128, 328, 330­ strategies for improving, 83, 103, 232, 331 239­243, 252 Scopes of work (SOW), 3­4, 36 structural aspects, 232, 233­234 beneficiary satisfaction surveys, 250­251 technical assistance to improve, 98, 192­ case review functions, 9, 112 220, 230­231, 236­239 CMS and QIO staff expertise for, 65 variations in service delivery, 5, 20­21, competition, 72­73 83, 236 conflict of interest restrictions, 73 Quality Partners of Rhode Island, 223 contract competition, 95

OCR for page 515
INDEX 515 data collection assistance, 106, 107 contract renewal, 259, 345­346 definition, 334 core contract, 181­182 development timetable, 15­16, 77, 132 deliverables, 430­433 educational and communication distinguishing features, 7, 48­51, 190 functions, 67 educational and communication fifth, 44, 45, 179 interventions, 67, 279­280, 283, first, 41 285­288, 293­294 fourth, 44­45 funding, 69, 179, 186­187 funding, 67, 69, 70, 140, 179, 180 home health agency technical assistance, home health agency technical assistance, 266 205­208 Hospital Payment Monitoring Program, hospital technical assistance, 208­213 311­315, 320­322 knowledge transfer incentives, 251 hospital public reporting, 285­287 long-range planning, 120­121, 132 hospital technical assistance, 268 ninth, 15­16, 18, 127­128, 129, 131, information technology in, 106, 107 132, 139­140 knowledge transfer in, 250­251 National Quality Coordination Board managed care organization technical implementation and, 94 assistance, 272 nursing home technical assistance, 201­ nursing home technical assistance, 264­ 204 265 origins and development, 41­52 performance data collection, 341, 342 performance evaluations, 10, 60, 76, performance improvements among 77 identified participants, 272­273 performance planning requirements, 171 population health initiatives, 98 population health promotion in, 98 private practice technical assistance, private practice technical assistance to, 269­270 213­218 program priorities in, 129, 352 program priorities, 9, 129, 199­200 provider satisfaction, 273­275 QIO management and, 134 QIO Support Centers, 173 QIO Support Center functions and, 133 service to underserved populations, 64, recommendations for improving, 14­16, 271­272 126­128, 129, 130­132 special studies, 357, 402­403 second, 41­42 subcontracting in, 171­172 service to underserved populations, 218­ support contracts, 184­185, 357, 399­ 220 401 sixth, 48, 64, 179, 341­342 technical assistance evaluation technical assistance provisions, 192, methodology, 257­259, 262­264, 227­228 404­409 tenth, 140 technical assistance in, 66, 192, 200, third, 43 201­202, 205, 207­209, 213, 218­ timeliness of data collection, 122 220 transition of contract during, 348 use of data from, for QIO program See also Eighth SOW; Seventh SOW analysis, 28­29, 30, 38­39, 146, Seventh SOW 149­150, 157­158 beneficiary protection activities, 112, Six Sigma program, 64, 240 308, 318­320 Small practice settings, 6, 26, 52, 104, 123 board characteristics and performance, Social Security Act, 40 71, 166­169 Socioeconomic status, quality of care and, 5, collaboration incentives, 60, 241 57 contract competition, 72, 73 Southeast Health Disparities Collaborative, contract management, 77 226

OCR for page 516
516 INDEX Special studies, 51 funding, 51, 69, 185 dissemination of findings, 184, 190, 353 for Hospital Payment Monitoring funding, 69­70, 184, 353 Program, 314 NQCB implementation and contracting knowledge transfer functions, 59, 246­ for, 94­95 247 oversight, 183­184, 356 obstacles to service delivery, 247 patterns and trends, 184 performance evaluations, 10, 77, 357, proposals, 183­184 359 recommendations for contracting, 14, recommendations for contracting, 14, 16, 126, 128 16, 126, 127, 128, 133­134 seventh SOW, 357, 402­403 redesign for eighth SOW, 173­175 Staff qualifications and characteristics, 64, 65 relationships with external stakeholders, CMS offices, 328 177 Government Task Leaders, 331­332 scopes of work and, 133 for information technology staffing, 178­179 implementation, 107­108 strategies for improvement, 178­179 length of QIO employment, 163­164, subcontracting, 171 190 technical assistance projects, 223­227 Project Officers, 329­330 timeliness of response, 178, 190, 247 QIO, implications of NQCB, 93­94 Support contracts QIO program full-time employees, 333 contracting procedure, 185, 353 QIO Support Centers, 178­179 finances, 10, 184­185, 357 recommendations, 16, 128 oversight, 74, 77, 185 Scientific Officers, 330­331 recommendations for, 16, 128 turnover, 164 seventh SOW, 184­185, 357, 399­401 Standard Data Processing System, 10, 75, See also Support Centers, QIO 334, 337 Surgical complications, 51 Standardization of performance measures, quality of care measures, 389­391 83­84 SurveyMonkey, 28, 149 Standards of care, 43 Systems-based measurement, 88 State Children's Health Insurance Program, 25, 62, 91 State QIO programs, 21 T Strategic Framework Board, 84 Technical assistance, 143­144 Strategic planning CMS role, 74, 351 activities of, 192, 193, 227 current QIO program, 9, 78­79 CMS evaluations of QIO performance, 200, 257­261, 277, 404­429 role of QIO boards, 72 Stroke, 48, 236, 237 confidentiality rules as obstacle to, 173 Subcontracting, 170­171 current system, 227­228 data collection and management, 96­97, Summative evaluation, 45 Supply of health care services, 20­21 123 Support Centers, QIO definition, 193 demand, 192 beneficiary protection activities, 308­ 309 funding, 18, 69, 70, 139, 192 CEO perceptions of, 175­179, 247 future challenges, 108­109 goals, 200 communication functions, 176 contracting, 94­95, 133, 349­350 to home health agencies, 205­208, 224­ expertise, 177 225, 266­268 for hospital public reporting, 286 functions, 2­3, 51, 133, 173­177, 190, 223, 228 to hospitals, 208­213, 225­226, 227, 268­269

OCR for page 517
INDEX 517 identification of high performers vs. low shortcomings of current system, 8­9 performers, 263­264 strategies for improving QIO to identified participants, 272­273 performance, 5­6, 7, 200­201 to improve services for underserved See also Private sector populations, 216­217, 218­220, Telephone help lines, 280, 287­288, 295 226­227, 271­272 Texas Hospital Association, 97 IOM evaluations of QIO performance, Texas Medical Foundation, 309, 314 262­272, 387­397 Timeliness in knowledge transfer, 144 of care, 24 to managed care organizations, 221­ of data collection and availability, 122, 223, 272 342­345, 358 needs assessment, 15, 127, 130 of Program Office response, 326 National Quality Coordination Board of public reporting, 283 implementation and, 96 of QIO response, 178, 190, 247, 274, 275 to nursing homes, 201­204, 223, 264­ To Err Is Human: Building a Safer Health 266 System, 19 one-on-one consulting vs. collaboratives, Total quality management, 44 197­198 Transformational change, 51, 52, 177, 352 Part D prescription drug benefit, 217­218 Transitions, care in performance data reporting current system, 2, 5, 21 requirements, 89 data collection, 129­130 to physicians' offices and practices, 213­ performance assessment, 9 218, 226, 227, 269­271 strategic planning for, 78 private organizations with quality See also Coordination of care improvement services, 99­100, 104 Transmittal of Policy System, 326, 327, 334 provider access and utilization, 59, 62­ Transparency 63 data confidentiality restrictions and, 7, provider­patient volume and, 194­195 74, 125 provider performance levels and, 67, QIO boards, 6, 71, 111­112 107, 109­110, 195­197 recommendations for QIO program, 16, provider satisfaction, 275 128 provider's status as industry leader or TRICARE, 62 early adopter and, 67, 107, 109­110, 194 purchase of, 62­63 U QIO self-assessments, 200­201 QIO Support Center activities, 223­227 Underserved populations education and communication for quality improvement, 98, 104 quality improvement outcomes, 144, interventions for, 293 230­231, 236­239 eighth SOW performance evaluation, 426­427 rationale for government role in, to improve quality of care, 61­62 QIO goals, 49, 64, 98 recommendations for, 4, 11, 14, 15, seventh SOW performance evaluation, 408­409 105­107, 109, 127 recruitment of identified participants, technical assistance to improve service 193­197, 227 for, 216­217, 218­220, 226­227, 271­272 role of QIO, 7, 22, 26, 66­67 rural area services, 212­213, 218­220 Utilization and Quality Control Peer Review in scopes of work, 192 Organizations. See Peer Review Organizations sensitivity to local needs, 198­199, 227 settings for, 66 Utilization review, 37, 39, 40, 42, 302

OCR for page 518
518 INDEX V W Veterans Health Administration, 25, 62, 91, Webpage views, CMS sites, 280, 295 92 Workforce retention, 51­52 Virginia Health Quality Center, 226

Representative terms from entire chapter:

podiatric medicine