Medicare's Quality Improvement Organization Program Maximizing Potential (2006) / Chapter Skim
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11 Beneficiary Education and Communications
11 Beneficiary Education and Communications
Pages 279-296
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From page 279... ...
charged the QIOs to in form beneficiaries about the purpose of the QIO program, their rights under the program, and how to exercise those rights (CMS, 2002, 2004b)
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In 2003, CMS began the Home Health Quality Initiative, which involved the public reporting of quality measures for home health agencies on the Home Health Compare website (http://www.medicare.gov/HHCompare/ home.asp.) In March 2005, CMS launched the Hospital Compare website (http://www.hospitalcompare.hhs.gov.)
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BENEFICIARY EDUCATION AND COMMUNICATIONS 281 1,600,000 1,400,000 1,200,000 1,000,000 NH Compare 800,000 HH Compare 600,000 Hospital Compare 400,000 200,000 0 Apr-04 Jun-04Aug-04Oct-04Dec-04 Feb-05Apr-05 FIGURE 11.1 Numbers of webpage views (as of June 10, 2005)
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282 MEDICARE'S QUALITY IMPROVEMENT ORGANIZATION PROGRAM any Medicare-related question. It is not one of the help lines run by individual QIOs.
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. In the 7th SOW, the QIOs spent $33.5 million on Task 2a, which represents approximately 4.2 percent of the QIO core contract budget (personal communication, C
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284 MEDICARE'S QUALITY IMPROVEMENT ORGANIZATION PROGRAM TABLE 11.2 Home HealthRelated Calls to 1-800-MEDICARE Number of Calls Number of Calls Number of HHa Date Related to HHa Quality Related to HHa Compare-Related (mo-yr) Initiative Overview Quality Measures Calls Jan-04 9 11 142 Feb-04 9 3 101 Mar-04 4 4 70 Apr-04 2 1 90 May-04 4 1 72 Jun-04 5 4 110 Jul-04 NAb 4 86 Aug-04 9 2 144 Sep-04 2 1 109 Oct-04 8 3 107 Nov-04 9 1 124 Dec-04 8 6 133 Jan-05 10 4 156 Feb-05 9 3 131 Mar-05 10 3 156 Apr-05 25 4 NAb May-05 14 2 NAb NOTE: Data are as of June 10, 2005.
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BENEFICIARY EDUCATION AND COMMUNICATIONS 285 Number of Calls Number of Calls Concerned that Concerned that the HHa Compare HHa Compare is Number of HHa- Total Number Website is Down Moving Slowly Related Complaints of Calls 3 4 35 204 4 2 35 154 7 2 54 141 11 2 48 154 9 4 33 123 31 NAb 43 193 NAb NAb 44 134 NAb NAb 95 250 NAb NAb 77 189 NAb NAb 75 193 NAb NAb 74 208 NAb NAb 70 217 NAb NAb 86 256 NAb NAb 81 224 NAb NAb 87 256 NAb NAb 97 126 NAb NAb 68 84 the multitude of measures confuses the public and the public cannot judge what is a good and what is a bad nursing home." · "Public reporting spurs culture change -- facilities want to improve; otherwise, they might lose clients. Once the data are in front of them and they know they are so far behind they show great determination to turn around." · "Fear of public reporting is what helps get hospitals and other providers to focus on quality and realize that they have to do something." As of this writing, CMS had not defined any specific duties related to public reporting for the 8th SOW (CMS, 2005b)
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. In the 7th SOW, QIO contract performance success on Task 2b was based on:
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. In the 7th SOW, the QIOs spent $38.3 million on Task 2b, which represents approximately 4.8 percent of the QIO core contract budget (personal communication, C
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. ROLE OF QIOS IN BENEFICIARY EDUCATION: TELEPHONE INTERVIEWS Nineteen QIO CEOs responded to questions about whether beneficiary education added value to quality improvement efforts and whether this function should continue.
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BENEFICIARY EDUCATION AND COMMUNICATIONS 289 BOX 11.1 Annual Medical Services Review Report "Annual Medical Services Review Report: State: Name of QIO: Time Frame: A Beneficiary Complaints Under Medicare law, Quality Improvement Organizations (QIOs)
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290 MEDICARE'S QUALITY IMPROVEMENT ORGANIZATION PROGRAM BOX 11.1 Continued "Complaint Cases with Confirmed Concerns: The Setting or Provider Number and Percent of Confirmed Concerns for the State Total Number Care Setting or Care Provider of Concerns Number Percent Hospital Skilled Nursing Facility (SNF) (includes SNF, swing, and swing critical access)
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In other cases where a hospital issues a HINN, but the patient does not immediately ask for a review, the QIO automatically reviews the case after the fact in what is called `retrospective review.' In all reviews, the QIO staff looks carefully at the patient's medical record to decide if an admission or continued stay is/was needed. "Beneficiary Notice Reviews Review Results Appropriate Inappropriate Cases Cases Type/Timing Number (Agree with (Disagree of Review of Cases notice)
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292 MEDICARE'S QUALITY IMPROVEMENT ORGANIZATION PROGRAM BOX 11.1 Continued Review Results Appropriate Inappropriate Cases Cases "Type/Timing Number (Agree with (Disagree of Review of Cases notice) with notice)
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BENEFICIARY EDUCATION AND COMMUNICATIONS 293 "Are we trying to have a more satisfied beneficiary pool or are we trying to improve the value of health care? But there are some projects where involving beneficiaries would be beneficial." Leveraging Education Funding Among the 14 CEOs who favored continuing beneficiary education activities, three added that although they thought that this function should continue, the amount of money available allows the QIOs to do only a meager amount of education and that they did less education during the 7th SOW than during the 6th SOW.
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is a public website, available to both consumers and providers, that displays information about the QIO program and allows the sharing of knowledge. For providers, MedQIC presents specific stories and tools submitted by all QIOs on effective intervention programs for each of the task areas.
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2004a. The Quality Improvement Organization Program: CMS Briefing for IOM Staff.
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