Medicare's Quality Improvement Organization Program Maximizing Potential (2006) / Chapter Skim
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. The QIO program consists of a set of federally administered contracts that support QIO services in each state, as well as special studies and program support services at the national level.
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health care in the 21st century and implementing a national performance measurement and reporting system that can support quality improvement efforts. The QIO program encompasses 41 organizations that hold 53 contracts with CMS to provide services in all 50 states, Puerto Rico, the Virgin Islands, and the District of Columbia.
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The recommendations offered in this report for restructuring the QIO program are intended to spur more rapid improvement in health care quality. This restructuring of the QIO program, in coordination with the use of performance measurement, reporting, and payment incentives (addressed in the other reports in the IOM's Pathways to Quality Health Care series)
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· The existing evidence is inadequate to determine the extent to which the QIO program has contributed directly to those improvements. · The QIO program provides a potentially valuable nationwide infrastructure dedicated to promoting quality health care.
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As implementation of a broad national performance measurement system proceeds and payments increasingly reward quality improvement, the need for technical assistance for quality improvement efforts will increase. The QIO program's nationwide coverage, support resources, and partnering relationships with providers are distinct assets.
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Some providers, such as small physician practices, will have a particular need for assistance with reporting of performance measures and quality improvement in the future. In sum, the potential exists for a reconfigured QIO program to have a measurable positive impact on the quality of care for Medicare beneficiaries.
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Functions and Impacts of the QIOs The QIOs had three main functions under the 7th SOW: · Offer providers technical assistance in improving the quality of care through collaboratives or other interventions by supporting process redesign, data collection and interpretation for internal quality improvement, and dissemination activities related to the use of publicly available comparative quality data. · Provide education and communications for beneficiaries.
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The current concentration in the QIOs of all three functions -- technical assistance, beneficiary education and communications, and protection of beneficiaries and the trust funds -- contributes to several shortcomings: · Hostile attitudes among some providers and a reluctance to participate in QIO quality improvement activities. · Possible conflicts of interest that could limit the QIOs' aggressive pursuit of complaints, appeals, and problematic cases.
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The QIO program's strategic planning process should contribute to the alignment of the QIOs' technical assistance efforts with performance measurement, payment, and pay for performance. The new Part D prescription drug benefit represents another opportunity for QIOs to focus on the coordination of care across provider settings, because maintaining appropriate drug therapies is critical as a patient receives health care in multiple settings.
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These formulas indicate an excessive level of process management of the QIOs on the part of CMS and the need for greater strategic guidance. Lack of Evaluation of QIOSC and Other Contracts Nearly one-third of the total QIO program funding is allocated to contracts for QIOSCs, special studies, and support services.
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should strengthen and reform key dimensions of the QIO program, emphasizing the provision of technical assistance for performance measurement and quality im provement. These changes will enable the program to contribute to improved quality of care for Medicare beneficiaries as they move through multiple health care settings over time.
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...... Recommendation 2: QIOs should actively encourage all provid ers to pursue quality improvement and should assist those pro viders requesting technical assistance; if demand exceeds re sources, priority should be given to those providers who demonstrate the most need for improvement or who face signifi cant challenges in their efforts to improve quality.
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...... Data Processing Recommendation 5: The secretary of DHHS and CMS should re vise the QIO program's data-handling practices so that data will be available to providers and the QIOs in a timely manner for use in improving services and measuring performance.
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Congress, the secretary of DHHS, and CMS should improve their management of the QIO program as necessary to support those goals, especially by enhancing con tracting processes for the QIO core contract and QIO Support Cen ter (QIOSC) contracts; integrating the program's core, support, and special study contracts; and improving coordination and communi cation within the program.
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Such information might be complemented by information from focus groups conducted with a mix of representatives from the various settings. The QIO core contracts and the QIOSC contracts should in clude incentives aimed at promoting a broader transfer of knowledge concerning successful quality improvement inter ventions and more rapid improvement.
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In particular, the roles and responsibilities of and communications among Project Officers, Contract Officers, Government Task Leaders, Scientific Officers, and QIO executives and their staff should be clarified. CMS should build self-assessment, transparency, clearer com munications, and continuous quality improvement into the daily workings of the team overseeing the QIO program, just as the QIOs expect providers to do.
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...... QIO Program Funding Recommendation 8: Congress and the secretary of DHHS should focus all QIO resources on supporting health care providers' per formance measurement and quality improvement efforts.
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· Once a national performance measurement and reporting sys tem has been established, its priorities should help guide the funding levels and policy direction of the QIO program, recog nizing that adequate funding is necessary to reach the goals set for the QIO program. · The secretary of DHHS should ease the conflict-of-interest re striction with regard to supplementing the QIO quality improve ment budgets with external funds.
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