Medicare’s Quality Improvement Organization Program Facing Unprecedented Lapse

Washington, D.C.— The American Health Quality Association (AHQA) expresses deep concern about the immediate and long-term impacts of a recently announced lapse of up to four months in the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) program will have on the Medicare quality infrastructure.

“This is the most existential crisis that the QIN-QIO infrastructure has faced since its inception,” said Alison Teitelbaum, Executive Director of AHQA. “The loss of key personnel and subsequent dismantling of the Quality Improvement infrastructure is detrimental to Medicare beneficiaries and the providers that care for them. CMS has spent the last 30 years building up the most innovative and valued quality improvement system across the entire federal government, and it is now letting that program atrophy,” continued Teitelbaum.

The Centers for Medicare and Medicaid Services (CMS) announced that the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) program may lapse for as long as 4 months in a June 26 notice sent to quality contractors. Since July 17, the QIN-QIO program has ceased to provide quality improvement technical support to Medicare participating hospitals, doctors, and post-acute facilities.  CMS also ordered all referred casework from Medicare beneficiary quality complaints to cease as of July 17.

AHQA is deeply concerned about the immediate and long-term impacts this lapse is having on the Medicare quality infrastructure. In addition to the mandatory functions of the program terminating, there have been national layoffs and furloughs of QIN-QIO staff, including physicians, nurses, and health quality experts with decades of experience. As the lapse continues, those staff will be faced with hardships and the need to find alternative employment; representing a devastating migration of expertise out of the QIO sector.

The QIO program is a mandatory federal program with specific requirements to deliver technical assistance to Medicare providers for the purposes of quality improvement. QIOs are required to be independent and impartial so they can work as a trusted partner across multiple settings of care. In the last statement of work, QIOs have made incredible progress to improve the health status of communities through direct beneficiary engagement, reduced hospital readmissions, improved nursing home care, helped physicians navigate the new Quality Payment Program, and saved the Medicare Trust Funds billions of dollars.

Congress modernized the QIO program in 2011 to provide CMS with requested changes to the program to make the program easier to administer; most notably reducing the number of QIO contracts through the regionalization of the previously state-based program. During this reform, the AHQA was assured that the savings would drive more resources to fieldwork and make the program more stable. However, the QIN-QIOs received less than 19% of overall QIO program expenditures in the first post-reform statement of work and are facing an unprecedented lapse in the first post-reform rebid. “Following the 2011 reform of the program, we hoped that we would see increased transparency and funding for this program. Unfortunately, we have seen neither and instead are witnessing one of the first complete shutdowns of the program since its inception,” said Teitelbaum.

AHQA is asking CMS to prioritize the award of the next 5-year statement of work for the QIN-QIO program, and to execute an immediate no-cost extension of the last statement of work so that the mandatory functions of the program supporting Medicare beneficiaries and providers can re-commence immediately.

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.