MEDICARE LOOKS FOR WAYS TO BOOST QUALITY CARE COMMENTS SOUGHT ON NEW PLAN FOR QUALITY IMPROVEMENT ORGANIZATONS
The Centers for Medicare & Medicaid Services today took another important step to assure that every patient receives the right care at the right time with a new proposal for its Quality Improvement Organizations (QIOs).
"The Quality Improvement Organizations are a key part of our efforts to improve the quality of care in the nation's health care system," said CMS Administrator Mark B. McClellan, M.D., Ph.D. "We know there are areas where there are substantial gaps between known good practice and actual practice, and we know dramatic improvement is possible. We now have more opportunities than ever to close those gaps, so that every Medicare beneficiary gets the right care every time he or she receives medical treatment."
QIOs are local organizations that, by law, contract with CMS to provide quality improvement assistance to health care providers, such as physicians, hospitals, nursing homes and home health agencies, and to health plans that contract with Medicare.
To help the QIOs, CMS is proposing an 8th Scope Of Work (SOW), a plan that represents significant enhancements on previous QIO contracts in three respects:
- It recognizes that although the U.S. healthcare system has been leading the way in many improvements in health care, the full potential of our health care system to improve health is not being achieved. The plan aims to promote dramatic improvements in the quality of health care so that every person receives the right care every time.
- It proposes that the QIOs may need to build on their current efforts to involve other organizations and entities to provide the best possible expert assistance in increasingly specialized areas, and invites comments on options for accomplishing this through subcontracting and other partnerships.
- It indicates that the design of the program will be organized to better distinguish QIO impact from improvement that may occur without QIO assistance, such as increased awareness of clinical guidelines by physicians.
Dr. McClellan said CMS, working with the QIOs, wants to see improvements that could transform the quality of life for Medicare beneficiaries. For example, 27 percent of people with Medicare did not receive annual flu vaccinations in 2002. Flu vaccines could prevent as many as 22,000 deaths annually, according to preliminary research of the available literature. Under this plan, QIOs will assist in closing the gap between poor performing nursing homes and those practicing "right care."
The 8th Scope of Work will guide the work of the QIOs for the three-year cycle beginning in August 2005. CMS invites public comment on the proposal by September 20. The proposal and comments will be used in developing the full Scope of Work, and for determining the level of funding for the program.
The proposal focuses attention in four settings-nursing homes, home health agencies, hospitals, and physician offices-as well as protecting beneficiaries and the Medicare Trust Fund through work on appeals, beneficiary complaints, payment error and other case review activities. It moves beyond the current 7th SOW in the following respects:
- QIOs will work to promote dramatic improvement, promoting the adoption and effective use of healthcare information technology (HIT), performance measurement, process redesign, and organizational culture change. For example, working with partners in a pilot project, QIOs are assisting small-to-medium sized physician offices in California, Arkansas, Massachusetts, and Utah, in adopting office-based electronic health record (EHR) systems and using such systems to improve efficiency of care delivery, quality of care and patient safety.
- When the Medicare prescription drug benefit becomes available in 2006, QIOs will work with prescription drug plans and providers to ensure quality care to people with Medicare on improvement projects such as measures to detect inappropriately prescribed drugs and ways to identify patients who may be at risk for harmful interactions.
- QIOs will work to improve care for disadvantaged populations by focusing on physician office-based care to make sure all Medicare beneficiaries get the right preventive services and appropriate care for chronic diseases, such as diabetes.
- QIOs are expected to continue offering mediation as a service to Medicare beneficiaries. This service involves direct provider involvement in responding to beneficiary complaints, which often results in improved communication between provider and patient in order to resolve quality of care issues.
These activities are a central part of CMS's overall strategy to improve the quality of health care services to Medicare beneficiaries. This multi-pronged approach includes helping consumers make decisions using timely and accurate quality of care information, and urging providers to improve quality using free assistance from the QIOs and through "pay-for-performance" demonstrations.
Beginning early in 2005, the hospital quality data will be available on a consumer Website, Hospital Compare, at www.medicare.gov, or by calling 1-800-MEDICARE (800-633-4227). Currently, CMS publishes quality information on www.medicare.gov for Medicare and Medicaid-certified nursing homes and Medicare-certified home health agencies.