Medicare QIOs: Scope of Work, 2002-2005

QIOs Expand From Hospitals and Ambulatory Care Into Long-Term and Home Health Care Quality Improvement Organizations (QIOs) are moving into additional health care settings under a new three-year contract with the Centers for Medicare and Medicaid Services. QIOs will provide services for Medicare beneficiaries in all 50 states, the District of Columbia, Puerto Rico, and the Virgin Islands from late 2002 through 2005 focusing on: Improving Hospital Care QIOs will continue hospital projects to improve clinical care for heart attack, congestive heart failure, and pneumonia—all major threats to the health of the Medicare population. These projects assist hospitals in establishing or refining clinical systems to more consistently provide the best care. Preventing Surgical Infections QIOs are implementing projects to reduce the incidence of post-surgical infections. These efforts will improve timely and appropriate use of prophylactic antibiotics before, during, and after surgery. Improving Care for Breast Cancer, Diabetes, Flu QIOs will continue outpatient projects to help physicians increase regular screening for breast cancer and improve care for diabetes among Medicare beneficiaries. QIOs will also continue to promote preventive influenza and pneumococcal (PPV) immunizations. Offering Assistance to Nursing Homes QIOs will provide technical assistance to help nursing homes implement better systems of care – with a focus on pain management, avoidance and treatment of pressure ulcers, prevention of infections, management of delirium, and improvement in walking. QIOs will also help the public interpret data published by CMS on the quality of care in individual nursing homes. Working With Home Health Agencies QIOs will offer agencies education and training to speed their adoption of Outcomes Based Quality Improvement (OBQI) methodology and techniques. QIOs will help the public understand CMS-published data on quality of care offered by home health agencies. Reducing Racial, Ethnic, and Rural Health Disparities In addition to continuing projects that help eliminate disparities in care received by ethnic and racial minorities, QIOs will launch new projects to improve care in rural areas. Protecting and Informing Patients QIOs are establishing Consumer Advisory Councils to increase communication with Medicare beneficiaries and consumer awareness about quality of care. In addition, QIOs will continue to review written complaints alleging inadequate quality of care. To make the complaint review process more consumer-friendly, case managers will be assigned to assist beneficiaries in using the review process, and QIOs will offer mediation in some cases to help resolve complaints. QIOs will continue to respond to requests for review of hospital non-coverage notices and review Emergency Medical Treatment and Active Labor Act (anti-patient dumping law) cases. Supporting Hospital Reporting on Quality QIOs will help hospitals measure and report data on the quality of the care they provide, laying the groundwork for reporting to the public. QIO assistance to hospitals will help them comply with new standards set by the Joint Commission on Accreditation of Healthcare Organizations. Developing New Methods to Advance Quality of Care QIOs will continue to conduct special projects to find new ways to speed improvement in care systems. For example, a four-state special QIO study in the mid-1990s led to the successful ongoing national QIO effort to improve heart attack care. One study now being planned will spur measurement and improvement of care provided in doctors’ offices to patients with chronic diseases. QIOs will also begin helping Medicare study the incidence of adverse events through the Medicare Patient Safety Monitoring System. Reducing Payment Errors QIOs will continue to monitor payment errors for hospital services, as well as to ensure Medicare inpatient hospital admissions are medically necessary.

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