Medicare's Quality Improvement Organization Program Maximizing Potential (2006) / Chapter Skim
Currently Skimming:
13 CMS Oversight
13 CMS Oversight
Pages 325-360
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 325... ...
Finally, there is an examination of how CMS provides overall guidance to the Quality Improvement Organization program through strategic planning, policy decision making, coordination, and overall pro gram evaluation. ORGANIZATIONAL STRUCTURE OF QIO PROGRAM IN CMS Oversight of the Quality Improvement Organization (QIO)
|
From page 326... ...
. Program Office Overall responsibility for the QIO program lies in CMS's Office of Clinical Standards and Quality, with direct oversight provided by the Quality Improvement Group (Jost, 1991; CMS, 2004c)
|
From page 327... ...
During the site visits, two QIOs raised issues about conflicting messages between the Program and Contracts Offices. Additionally, at CMS's annual technical conference for the QIO program (QualityNet 2004)
|
From page 328... ...
The four Regional Offices with Divisions of Quality Improvement (referred to in the QIO program as "Regional Offices") assist QIOs with technical issues on a daily basis by interpreting CMS policy, monitoring finances, and providing feedback.
|
From page 329... ...
CMS OVERSIGHT 329 Project Officers Project Officers monitor technical aspects of the QIO core contract (CMS, 2004b)
|
From page 330... ...
Data are for a total of 52 QIOs. HCQIP = Health Care Quality Improvement Program.
|
From page 331... ...
CMS OVERSIGHT 331 Semi-Weekly, 6 Only as needed, 17 Quarterly, 3 Monthly, 22 FIGURE 13.2 Frequency of Scientific Officer contact with QIOs reported by 48 QIOs. The numbers in the figure represent the number of QIOs responding as indicated.
|
From page 332... ...
332 MEDICARE'S QUALITY IMPROVEMENT ORGANIZATION PROGRAM TABLE 13.5 QIO Ratings of Scientific Officers Clarity of Timeliness Timeliness of Rating Responsesa of Responsesb Manuscript Reviewsc Excellent 17 17 18 Good 24 29 14 Fair 6 2 1 Poor 0 0 2 aData are for a total of 47 QIOs. bData are for a total of 48 QIOs.
|
From page 333... ...
The breakdown is presented in Table 13.6. COMMUNICATIONS AND INFORMATION TECHNOLOGY SERVICES Communications QIO Manual and Contract Many conduits of communication exist within the QIO program (CMS, 2004b)
|
From page 334... ...
334 MEDICARE'S QUALITY IMPROVEMENT ORGANIZATION PROGRAM which lays out basic program policy on the basis of legal and agency requirements and which is unlikely to change during the course of a contract. The QIO contract itself is another source of information for QIOs.
|
From page 335... ...
Medicare Quality Improvement Community The Medicare Quality Improvement Community (MedQIC) (formerly known as the Medicare Quality Improvement Clearinghouse)
|
From page 336... ...
More than half of the QIOs rated MedQIC as "fair" in each case. As MedQIC was redesigned in early 2005, an effort spearheaded by the 7th SOW's Quality Improvement Interventions and Related Resources QIOSC, Figure 13.4 does not reflect the value or ease of use of the new version of MedQIC.
|
From page 337... ...
also fall under the umbrella of SDPS. SDPS became operational in May 1997 in response to the needs of the QIO program and interfaces with the Central Office, the 53 QIOs, and the Clinical Data Abstraction Centers (CDACs)
|
From page 338... ...
338 MEDICARE'S QUALITY IMPROVEMENT ORGANIZATION PROGRAM TABLE 13.7 QIO Ratings of SDPS Rating Value Timeliness of Support Overall Ease of Use Excellent 8 4 6 Good 25 19 21 Fair 12 18 20 Poor 7 11 5 NOTE: The data in the table represent the number of QIOs responding as indicated. Data are for a total of 52 QIOs.
|
From page 339... ...
SOURCE: IOM committee web-based data collection tool. reports on activities and projects, information on publications, data on identified participants, and project proposals.
|
From page 340... ...
340 MEDICARE'S QUALITY IMPROVEMENT ORGANIZATION PROGRAM A B Poor, 0 Excellent, 5 Excellent, 8 Poor, 8 Fair, 20 Good, 12 Good, 24 Fair, 27 FIGURE 13.8 Value (A) and ease of use (B)
|
From page 341... ...
. Nursing Homes and Home Health Agencies In the 7th SOW, CMS obtained performance data for nursing homes and home health agencies from the Center for Medicaid and State Operations, which generated nursing home measures from data collected with the Minimum Data Set tool and home health agency measures from data collected with the Outcome and Assessment Information Set tool.
|
From page 342... ...
In the 8th SOW, due to the duplicative efforts of the Hospital Quality Alliance and the reporting requirements of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (P.L.
|
From page 343... ...
. However, a recent study of hospitals not participating in specific quality improvement interventions showed no difference in performance measures between hospitals that received immediate feedback and those that received data that were delayed 17 months (Beck et al., 2005)
|
From page 344... ...
344 MEDICARE'S QUALITY IMPROVEMENT ORGANIZATION PROGRAM recognize that they cannot abstract information at all facilities or for all providers because of limited resources. Nursing Homes and Home Health Agencies Five of 20 CEOs mentioned problems with nursing home data, and four mentioned delays with home health data.
|
From page 345... ...
CMS OVERSIGHT 345 use proxy measures like the number of improvement plans drawn up; CMS does not give enough credit for these proxy measures." With respect to gaining access to data directly from physicians' offices, one CEO believed that "CMS doesn't trust QIOs with physician data, but the CMS data [are] old when we get [them]
|
From page 346... ...
. The major reasons against routine competition that the CEOs cited were the potential for the loss of momentum in quality improvement, the loss of knowledgeable staff, the length of time needed to develop relationships with the provider community, decreased sharing, and perhaps even less innovation.
|
From page 347... ...
The other four said that they could accept competition but believed that the QIO program is better off with the incumbent, as long as there is not a nonperformance issue. One of these CEOs commented that a "Baldrige award winner said winning is a culmination of a 10-year journey; it is not something that happens overnight.
|
From page 348... ...
, the incumbent QIO begins 8th SOW activities along with all the other QIOs. If the contract is eventually awarded to a different organization, the incumbent assists the successor by use of a transition plan that familiarizes the new contractor with state activities, including the provision of materials for case review and quality improvement activities.
|
From page 349... ...
In the telephone interviews, the QIO CEOs related that a lack of provision of data in a timely manner has implications for the length of the QIO contract and the perceived unfairness of the CMS evaluation. Eleven of the 20 CEOs mentioned that the lack of timeliness made the 3-year contract time frame inappropriately short because, first, it did not allow sufficient time for the provision of feedback data on quality improvement changes by providers and, second, the data that CMS uses to monitor whether the QIOs had met their performance requirements did not reflect the work that they had done.
|
From page 350... ...
350 MEDICARE'S QUALITY IMPROVEMENT ORGANIZATION PROGRAM must move ahead on its own. The QIOs in the first round were particularly affected and had to start the new tasks with no QIOSC materials.
|
From page 351... ...
After considerable internal discussion, external stakeholder groups offered advice on how transformational change could be achieved. The meetings of the stakeholder groups, including representatives of QIOs, were organized according to the main provider settings addressed by the QIO program: home health agency providers, hospitals, nursing homes, and physicians' practices.
|
From page 352... ...
. In the 8th SOW, the tasks of the QIO program reflect a major change from measurement-based quality improvement to assisting providers with achieving transformational change (Rollow, 2004)
|
From page 353... ...
Overall, the focus group participants believed that DHHS as a whole needs to align its priorities to provide incentives for quality improvement, such as through the implementation of regulatory requirements and pay for performance. Program Coordination The QIO program is only one of several health care qualityrelated efforts under way within CMS, which increases the need for coordination within Medicare and CMS as a whole.
|
From page 354... ...
The Quality Council strives to coordinate all CMS efforts related to quality as well as to align those efforts with the quality improvement activities of other public and private organizations (Jencks, 2004)
|
From page 355... ...
Five QIOs wanted more flexibility in the program in terms of either quality improvement topic areas or how goals are achieved. In interviews with five organizations representing seven QIOSCs, QIO staff members also mentioned difficulties in their relationships with CMS's Central Office and with their Government Task Leaders.
|
From page 356... ...
Also, no system exists for broadly sharing the knowledge acquired through the studies or even letting all the QIOs and other Project Officers and Government Task Leaders know which QIO is working on a particular special study topic. The Quality Improvement Group was unable to provide the IOM committee with information on the various contracts at a level of detail sufficient for the committee to know what the contracts are supposed to accom
|
From page 357... ...
The web-based data collection tool attempted to gather opinions about other QIOs by the QIO community itself, but the results were inconclusive. More importantly, neither CMS nor independent researchers have performed a conclusive evaluation of the impacts of the 53 QIOs on quality improvement nationally.
|
From page 358... ...
· Although CMS is developing a strategic plan for the QIO program 12 years into the future, the program still lacks distinct, focused priorities. Neither the core contracts nor the associated evaluation schemes prioritize the QIO activities.
|
From page 359... ...
2004b. The Quality Improvement Organization Program: CMS Briefing for IOM Staff.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.