Medicine and Health Aug. 5, 2002 Quality Improvement QIOs: MORE DEMANDS, FEWER RESOURCES The good news, according to David Schulke, executive vice president of the American Health Quality Association: Under the Centers for Medicare and Medicaid Services' quality improvement initiative for nursing homes, facilities are requesting help from quality improvement organizations, which AHQA represents, at a much higher than expected rate. The bad news: The budget for the QIOs, formerly known as peer review organizations, is lower in this three-year cycle of funding - the seventh "scope of work" ¾ than in the last, but QIOs have more work, notably significantly more duties involving nursing homes and other providers like home health organizations. In an August 1 conference call with reporters, Schulke said CMS recently gave QIOs a third of the $100 million they need just to get back to the budget they had in the previous cycle. The agency transferred the funds from a pot of money that provides administration and support for quality improvement but doesn't go directly to the QIOs. According to Schulke, the reprogramming of funds reflects a change in the thinking of CMS administrator Tom Scully. Scully "started out skeptical about whether the quality improvement part of [the nursing home] initiative would produce gains. He thought the ads and the public release of the data would produce the big change," Schulke said, referring to information CMS has posted in newspapers and on the Internet listing facilities' performance on quality indicators such as rates of pressure sores and excessive weight loss. But as Scully visited skilled nursing facilities and QIOs, "he became aware that this was worth investing money in," Schulke said. For funding beyond the $35 million, QIOs and CMS must depend on the Office of Management and Budget, which has the authority to release QIO funding from the Medicare trust fund. Schulke said he was optimistic on this front, partially because, with Scully's new thinking, the budget agency "will see that the administrator does not intend to spend all of this money on ads, which is one of the things that OMB had been skeptical of." Schulke was joined on the conference call by two representatives of the nursing home industry, and all parties said the quality initiative, begun as a pilot project in six states and slated to go national this fall, has led to a focus on quality by facilities and a cooperative, mutually informative relationship between QIOs and SNFs. However, industry representatives were less positive about the publicity end of the initiative, which Bush administration officials have long touted as the centerpiece. "Most of us would rather see the money put into" quality improvement efforts rather than more newspaper ads beyond the second round of ads already scheduled for October, said Suzanne Weiss, vice president of the American Association of Homes and Services for the Aging. Sandy Fitzler, director of clinical operations at the American Health Care Association, said providers have concerns about whether the measures are "valid" and "based on the best available science." Weiss and Fitzler said providers would like to see quality measures stated in more positive ways. For instance, rather than saying 17 percent of a facility's residents have pressure ulcers, said Weiss, "a much healthier way to look at it" is to say that "83 percent of the residents in that facility are ulcer-free, which is a very good thing."