New CMS Data Show Quality Improvement Organizations Improved Care for Nation’s Medicare Beneficiaries

Nation’s Quality Improvement Organizations Prove Instrumental in Reducing Hospital Readmissions, Health Care Associated Infections

June 12, 2014

Washington, D.C.—New data from the Centers for Medicare & Medicaid Services (CMS) show that the nation’s Quality Improvement Organizations (QIOs), working in close partnership with providers, federal, state and private partners and others in local communities, have prevented more than 95,000 hospitalizations and 27,000 hospital readmissions among Medicare beneficiaries. From October 2010 to March 2013, CMS data indicate that hospital readmissions among Medicare beneficiaries declined by 13.22 percent in QIO communities, compared to a national drop of 12.55 percent. Similarly, hospital admissions also declined further in QIO communities—by 8.39 percent vs. 8.12 percent nationally—pointing to the efforts of QIOs as an important lever in improving health care quality nationwide.

By improving care transitions—when patients move from one care setting to another, such as from a hospital to their home—these reduced hospitalizations, including in QIO communities, resulted in a cost savings of nearly $1 billion. While progress has been made nationwide to improve care transitions and reduce the number of patients who return to the hospital within 30 days, CMS’ findings indicate that readmissions have been reduced further in communities where QIOs play an active role.

“QIOs work in close partnership with physicians, nurses and other members of the interdisciplinary team across settings—forming a network that helps patients remain healthy long after they leave the hospital,” said Adrienne Mims, MD, Vice President, Chief Medical Officer of Atlanta-based Alliant GMCF, the QIO for Georgia, and president of the American Health Quality Association (AHQA). “Because QIOs are part of the local community—neighbors, in fact—we’re able to constantly innovate and adapt, ensuring our efforts meet the unique needs of local seniors and their families. Successfully reducing readmissions takes the entire community.”

Keeping seniors out of the hospital is just one of many of the QIOs’ measurable improvements in the quality of care provided to the nation’s nearly 50 million Medicare beneficiaries. In intensive care units and other hospital units in more than 800 facilities nationwide, QIOs provide assistance to help reduce healthcare associated infections (HAIs). From February 2011 to August 2013, QIOs’ efforts resulted in a 53.0 percent reduction in central line associated blood stream infections.

A major source of HAIs is catheter associated urinary tract infections, or CAUTIs. One intervention for successfully reducing CAUTIs is to cut down on the number of days in which a patient needs a catheter. In total, QIO-assisted hospitals were able to reduce the total number of Medicare patient days in which a catheter was used by more than 85,000 days nationwide.

“As rates of chronic disease increase and the baby boomer generation ages, it’s essential that we improve the quality of health care provided to America’s seniors,” said Todd Ketch, executive director of AHQA. “We owe them an improved care experience, so that they may maintain their quality of life for as long as possible. There is an imperative to achieve substantially better quality, improved safety and increased efficiency in health care. Ensuring seniors receive the right care at the right time, and empowering them to make informed decisions about their own care also brings down health care costs, which ultimately benefits everyone.”

Funded by the federal government, Medicare QIOs have been working to improve patient care for 30 years by collaborating with providers, consumer advocates and others to improve health care delivery, safety and efficiency in every state and U.S. territory. The national network of QIOs is the country’s longest-standing, nationwide program to improve health care quality. In August 2014, CMS will implement a new contract for QIOs—aligned with the U.S. Department of Health & Human Services’ National Quality Strategy and specifically focused on improving the health status of communities; providing beneficiary-centered, reliable, accessible and safe care; and providing better care at a lower cost.

“Our nation needs to support quality improvement and technical assistance to providers at the local level to achieve higher quality of care, prevent patient harm, and improve health outcomes,” said Patrick Conway, MD, MSc, Chief Medical Officer for CMS and Deputy Administrator for Innovation and Quality. “Quality Improvement Organizations have driven major improvement in quality of care across the nation and in the years ahead, our work with QIOs will focus on coordinating patient care across settings, reducing health care associated infections, improving care for common conditions like diabetes and heart disease, and more.”

AHQA represents the national network of QIOs working to advance the quality of health care for America’s Medicare beneficiaries. In every state, QIOs work hand-in-hand with local providers, consumers, and stakeholders across the continuum of care—including in hospitals—to help ensure that when our nation’s Medicare beneficiaries receive medical care, regardless of the setting, it’s the best and safest care possible.

Media Contact:

Todd Ketch | (202) 331-5790 | tketch@ahqa.org