Medicare's Quality Improvement Organization Program Maximizing Potential (2006) / Chapter Skim
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10 Evaluation of Quality Improvement Achieved by the QIO Program
10 Evaluation of Quality Improvement Achieved by the QIO Program
Pages 257-278
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From page 257... ...
At the end of the 3-year Quality Improvement Organization (QIO) program contracts, the Centers for Medicare and Medicaid Services (CMS)
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From page 258... ...
. Adding to the complexity of scoring, the clinical quality score for the nursing home, home health, and physician's office settings includes additional components: identified participant scores and statewide scores.
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From page 259... ...
and (2) approval of the Project Officer on all nonquantitative tasks (Tasks 1f, Task 2a and 2c, and Tasks 3a through 3c)
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From page 260... ...
QualityQuest Identified Participant Clinical Quality Score Calculation of Identified Participant Weight Identified participant nursing homes as a percentage of all nursing homes in the state = 13.8 percent Target percent participating = 10 percent Identified participant weight = 0.44 × (percent participating identified participants/target percent participating) Identified participant weight = 0.44 × (13.8 percent/10 percent)
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From page 261... ...
Therefore, QualityQuest has passed the satisfaction component and will receive a score of 0.2. Overall Nursing Home Improvement Score Overall score = 0.8 (clinical quality score)
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From page 262... ...
, as well as other data from CMS, as requested. In the interest of understanding why some states and provider settings showed more improvement on QIO quality measures than others, the committee conducted correlations between how the QIOs scored per clinical quality improvement task and the potential presence of confounding variables, such as performance on other Task 1 subtasks, the spending per beneficiary on that subtask, the QIO contract round, the QIO region, and provider satisfaction.2 The data used to determine correlations for all tasks were current through December 2004 and were obtained from the Dashboard section of CMS's internal website, unless noted otherwise.
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From page 263... ...
Also, the IOM committee did not detect any correlations between subtask improvement scores and QIO spending per beneficiary or provider satisfaction. Some association between the overall subtask score and the QIO contract round was shown only for the home health setting, suggesting that QIOs beginning in later contract rounds achieved greater improvements.
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From page 264... ...
Many other factors may have affected provider performance, such as quality interventions from other organizations, but CMS did not document these factors. The evaluation in the 7th SOW focused on specific measures, subtasks, and individual QIO performance and does not demonstrate the actual impact of the QIO program or attribute improvements to QIO interventions; however, they do show changes in specific quality measures in each state.
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From page 265... ...
. For Task 1a, the IOM committee found no correlations between overall improvement scores and QIO spending per beneficiary, nursing home satisfaction rates, the QIO contract round, or the QIO region.
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From page 266... ...
a statistically significant improvement in at least one indicator by 30 percent of the identified participants and (2) satisfaction with QIO performance by at least 80 percent of the participating home health agencies.
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From page 267... ...
measure (see Chapter 8 for a description of OASIS measures) for statewide improvement, and the home health agencies' plans to reduce acute care hospitalizations.
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From page 268... ...
. The IOM committee found that the hospital measure improvement rates did not correlate with spending on this task per beneficiary, the QIO contract round, or provider satisfaction.
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From page 269... ...
, including the implementation of systems improvement interventions, such as computerized provider order entry, bar coding, or telehealth. The eight deliverables for Task 1c2 include the submission of quality improvement measures, interventions, and change models as well as a safety culture survey (CMS, 2005c)
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From page 270... ...
As with the home health care analysis, this does not insinuate that 44 percent of the QIO contracts were not automatically renewed, as many could have scored above 0.6 point. The scores ranged from 0.13 to 2.4 points.
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From page 271... ...
Evaluation of performance on this subtask will be determined solely on the basis of the identified participants' activities and will be performed by the Project Officer and the Task 1d3 Government Task Leader. Achievement of the satisfaction and knowledge-perception surveys requirement is required to pass this subtask (discussed further in this chapter)
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From page 272... ...
. IMPACT OF INTENSE QIO ASSISTANCE In the 7th SOW, subsets of providers in the nursing home, home health care, and physician's office settings volunteered to work more closely with the QIO than other providers in the state; the QIO program recognizes
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From page 273... ...
. CMS contracted with Westat to survey all the identified participants; CMS also included a selection of nonidentified participants from the nursing home and home health settings for these surveys.
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From page 274... ...
274 MEDICARE'S QUALITY IMPROVEMENT ORGANIZATION PROGRAM TABLE 10.4 Summary of CMS Evaluation of 7th SOW Care Setting Physician's Evaluation Parameter Nursing Home Home Health Hospital Office Levels of intensity Nonidentified Nonidentified NAb Nonidentified participants, participants, participants identified identified and identified participants, participants, participants and select and select identified identified participantsa participants Number of measures 4/6 measures 10/11 measures 17/18 measures 2/4 measures improved improved improved improved improved Number of providers 13,000 providers 6,000 providers 3,700 providers 1.7 million or beneficiaries beneficiaries (approximate) Measurement periodc Q2c 2002 April 2002 2000 20012004 Q2 2004 January 2005 Q4c 2004 aSelect identified participants are identified participants focusing on improving a specific quality measure.
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. 8th SOW In the 8th SOW, the QIO program will continue to evaluate the satisfaction of providers as a component of Task 1 subtasks.
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From page 276... ...
The stakeholder survey will be conducted twice during the 3-year contract period and will measure how key health care system stakeholders view the QIOs and CMS. The QIO survey will allow the QIOs to voice their satisfaction or dissatisfaction about CMS's operation and management of the overall QIO program (personal communication, M
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From page 277... ...
SUMMARY This chapter has discussed issues related to evaluation of the impact of quality improvement in the QIO program. The following are some of the main themes of this chapter, which are reflected in the findings and conclusions presented in Chapter 2: · CMS evaluates QIO performance on the basis of a number of provider quality measures and deliverables provided for each task.
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From page 278... ...
2005. Survey for Provider Satisfaction with Quality Improvement Organizations.
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