Medicare's Quality Improvement Organization Program Maximizing Potential (2006) / Chapter Skim
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5 CMS Oversight of the Operations and Management of the QIO Program
5 CMS Oversight of the Operations and Management of the QIO Program
Pages 120-142
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From page 120... ...
program, including communications among the various program partici pants, data processing, strategic planning, and program evaluation and funding. CMS's current management is examined from two perspectives: the first considers how CMS could improve the opera tions of the QIO program in the short term; the second is a longer range perspective that considers how CMS and the QIO program might fit into the operations of a national performance measure ment and reporting system once it is fully implemented.
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From page 121... ...
the need for evaluations to determine what quality improvement methods do and do not work and under what circumstances, to assess the overall performance of individual QIOs, and to assess the impact of the QIO program overall on the quality of health care. Fundamental to each of these themes is the need for adequate funding, which is addressed in the committee's final recommendation.
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From page 122... ...
Now that CMS publicly reports data on hospitals, nursing homes, and home health care agencies on at least a quarterly basis, relatively current data are available for a very limited set of measures at a frequency greater than that in the past. A rapid expansion of the measures included in the publicly reported measure sets, as envisioned in the committee's first report, Performance Measurement: Accelerating Improvement (IOM, 2006)
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From page 123... ...
The centralized development of tools that physician offices could use independently would aid in the acquisition and use of health information technology and would perhaps help the QIO program reach a larger audience. Some physicians who are already using EHRs could also use specially designed tools on their own to produce aggregated data and analyses to guide their quality improvements efforts, as well as to facilitate the redesign of their practices to take advantage of the EHRs.
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From page 124... ...
. The current QIONet Exchange, designed for the transmission of clinical quality data in the QIO program, is also used for the hospital public reporting program because it is secure and is compliant with the mandates of the Health Insurance Portability and Accountability Act.
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From page 125... ...
(The publicly reported data from hospitals, nursing homes, and home health agencies are considered CMS data, not QIO data, and thus are not subject to the same confidentiality restrictions.) The current QIO confidentiality restrictions are not necessary or supportable in the current era of public reporting and are incompatible with the aim of a national performance measurement system and the goal of CMS to serve multiple audiences with a transparent system.
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From page 126... ...
QIO PROGRAM MANAGEMENT Recommendation 6: CMS should establish clear goals and strategic priorities for the QIO program. Congress, the secretary of DHHS, and CMS should improve their management of the QIO program as necessary to support those goals, especially by enhancing con tracting processes for the QIO core contract and QIO Support Cen ter (QIOSC)
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From page 127... ...
· Congress and CMS should change the contract structure for core QIO services for the 9th scope of work: Strong incentives and penalties that reward high performance and penalize poor performance should be included. CMS should encourage sufficient competition for the core contracts to permit the selection of a QIO contractor on the basis of contractor-proposed interim and final performance measures and goals.
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From page 128... ...
· CMS should award QIOSC contracts several months in advance of a new QIO contract cycle to allow for the preparation of tools and materials for QIO use, definition of the required tasks and deliverables that will serve the QIOs and the Government Task Leaders, and inclusion of explicit methods for assessment of the contractor's performance. Congress and CMS should al low entities other than QIOs with expertise in quality improve ment to bid on QIOSC contracts; familiarity with QIO work, the capability to carry out the work, and experience in perform ing the required functions should be appropriately weighted when the bids are assessed.
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From page 129... ...
Future QIO contracts will need to be more coherent and should include clearly stated priorities for QIO activities and precise goals for the SOW overall. Current quality improvement tasks are subdivided and evaluated by provider setting; there needs to be a new priority on improving care across provider settings.
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From page 130... ...
, it should be possible to identify various improvement methods, successful projects, and failures. QIOs should be encouraged to share their unsuccessful efforts and their best practices, and to transfer that knowledge broadly both within the QIO community and to other organizations, such as commercial health plans and provider organizations seeking to improve quality at the local and national levels.
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From page 131... ...
Because the 9th SOW will be significantly different from the 8th SOW, one cannot assume that organizations currently holding QIO contracts will be best suited to carrying out the new functions. Other entities that meet structural, staffing, and conflict-of-interest qualifications should be allowed and encouraged to compete.
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From page 132... ...
Much of the delay appeared to be related to internal departmental debates and budgetary discussions. Because these discussions would need to occur only every 3 or 5 years if the QIO contracts were extended as proposed by the committee, it would be helpful for the program office to establish an ongoing dialogue with the key parties to keep them informed of current program progress, as well as CMS's thoughts about the next SOW.
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From page 133... ...
This task coincides with the abovediscussed need for CMS and the QIO program to consider more of the crosscutting issues of health care delivery. The Quality Improvement Group in CMS administers not only the QIO core contracts and QIOSC contracts, but also other contracts with QIOs and other organizations that are intended to support the QIO program and quality improvement in general, as defined more broadly within the Medicare program.
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From page 134... ...
To ensure a smooth transition to the new SOW, all participants will need to understand CMS's priorities and policies, as well as those of a national performance measurement and reporting system as it develops. Perhaps some of the lessons QIOs learn in working with providers to improve their communications across various health care settings could be applied to better link the many offices within CMS that are involved with processing QIO contracts and working with the contractors.
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From page 135... ...
, when applicable. Evaluation of the program's success in achieving those goals, as well as its overall impact, has been largely ignored, and the focus has remained on evaluation of QIO contract performance alone.
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From page 136... ...
Thus evaluations must be used to determine the success of individual QIOs in achieving the results delineated in their contracts. The results of such assessments can help CMS judge the bids for future QIO contracts.
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From page 137... ...
, the committee is convinced that evaluations of the QIO program must be given high priority. Not only do the technical assistance methods used by QIOs with identified participants need to be examined, but the techniques they employ to improve quality statewide also need to be reviewed.
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From page 138... ...
(See Appendix C for descriptions of how each of the above methodologies might be applied to aspects of the QIO program when formal evaluation plans are designed.) QIO PROGRAM FUNDING Recommendation 8: Congress and the secretary of DHHS should focus all QIO resources on supporting health care providers' per formance measurement and quality improvement efforts.
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From page 139... ...
If the evaluations demonstrate that no positive impact is attributable to the QIO program's efforts, CMS will need to rethink its quality improvement approach and the possible ben efit of transitioning funds to an alternative structure and strat egy for Medicare. · Once a national performance measurement and reporting sys tem has been established, its priorities should help guide the funding levels and policy direction of the QIO program, recog nizing that adequate funding is necessary to reach the goals set for the QIO program.
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From page 140... ...
. Additionally, while most of the QIOs' current expenditures for Tasks 1a1d (quality improvement activities in nursing homes, home health settings, hospitals, and physician offices)
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From page 141... ...
Also, QIOs need to prevent perceptions of bias toward paying contractors that might arise if resources for free assistance became scarce. Finally, by removing this restriction, more organizations with multiple lines of business might be enticed to compete for QIO contracts.
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From page 142... ...
2005. QIO Program: Update and Policy Considerations.
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