Medicare's Quality Improvement Organization Program Maximizing Potential (2006) / Chapter Skim
Currently Skimming:
2 Assessment of the QIO Program: Findings and Conclusions
2 Assessment of the QIO Program: Findings and Conclusions
Pages 55-81
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From page 55... ...
Specifically, the chapter addresses whether: · There has been improvement in the quality of health care services provided to Medicare beneficiaries. · The QIO program has contributed to that improvement.
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From page 56... ...
whether the improvements, if any, can be attributed to the QIO program. Alternatives to the current QIO program, along with their advantages and disadvantages, are considered next.
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From page 57... ...
Can the gradual improvements in care that have been accomplished be attributed to the QIO program? Because of the nature of their evaluation designs, the studies mentioned above cannot be used to determine the cause of the improvements documented or attribute them to the QIO program.
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From page 58... ...
Also, the literature does not address the QIO program as a whole; rather, it merely addresses the impacts of specific quality improvement activities of individual QIOs or quality measures aggregated at the state or national level. Other aspects of the program, such as the impact of QIO case reviews on quality and the value of QIO Support Centers (QIOSCs)
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From page 59... ...
. Knowledge transfer is considered an important part of the QIO program, although evidence that it occurs is meager.
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From page 60... ...
While the QIO contracts and QIO collaboratives are based on sharing and knowledge transfer, other forces in health care are pushing providers in the opposite direction, toward more competition. Under the pressures of public reporting, no providers will want to see their name on the bottom half of the quality-of-care list, which would indicate that the care they provide is of below-average quality.
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From page 61... ...
Those 6 QIOs included some that would not generally be viewed as belonging in the bottom tier on overall performance, some that had received substantial contracts from CMS to conduct special studies or to serve as a QIOSC, and some that were named "best" at particular tasks by other CEOs according to the committee's web-based data collection tool. ALTERNATIVES TO THE CURRENT QIO PROGRAM In considering alternatives to the current QIO program, the committee decided it was necessary to step back and ask some fundamental questions.
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From page 62... ...
This is especially so for those who depend upon federal programs, such as Medicare, Medicaid, the State Children's Health Insurance Program, the Department of Defense's TRICARE, and the programs of the Veterans Health Administration and the Indian Health Service, which provide coverage and care to roughly 100 million people (IOM, 2002)
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From page 63... ...
PROGRAM INFRASTRUCTURE Given the committee's limited ability to attribute quality improvements in Medicare directly to the efforts of the QIO program, it is necessary to consider whether the current program should continue. Although it may appear obvious, the committee believes the existence of 41 separate organizations holding QIO contracts dedicated to providing quality improvement services in every state, the District of Columbia, Puerto Rico, and the Virgin Islands is a significant asset.
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From page 64... ...
. The following are examples of the QIOs' expertise and experience drawn from the committee's QIO and Regional Office site visits, telephone interviews, and web-based data collection tool: · All but seven QIO contracts are staffed with at least one employee who is a Certified Professional in Healthcare Quality (through the Healthcare Certification Board, the National Association for Healthcare Quality, or a similarly recognized professional accreditation in quality improvement)
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From page 65... ...
Both the convening ability of the QIOs and the clout of CMS to bring national organizations to the table are key ingredients for promoting widespread, coordinated quality improvement. The committee recognizes the expertise available within the QIO program and the enthusiasm, commitment, and dedication to quality improvement exhibited by staff and leadership from the Central Office at CMS, the Regional Offices, and all the organizations holding QIO contracts.
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From page 66... ...
Technical Assistance for Quality Improvement As discussed above and in detail in Chapters 9 and 10, the existing evidence concerning the impact of QIO quality improvement interventions is insufficiently robust to permit the attribution of improvements to QIO activities. This lack of evidence neither supports nor refutes the effectiveness of the QIO program, nor does the evidence make clear which QIOs are doing a better job of providing technical assistance for quality improvement.
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From page 67... ...
Indeed, ideally there should be sufficient resources for QIOs to assist all providers requesting help. The committee considers it important for the QIO program to focus on assisting providers at a low quality level or those that would be unable to obtain assistance through the private market, particularly with the expansion of public reporting and payfor-performance programs; however, those providers would not necessarily be unwilling, unready for change, or the slowest adopters of change.
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From page 68... ...
. Nearly all QIO CEOs consider case reviews to be a useful adjunct to the provision of technical assistance for quality improvement.
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From page 69... ...
Under the 7th SOW, funding for the 53 QIO core contracts was approximately two-thirds of the estimated total funding for the QIO program of $1.154 billion (see Chapter 7 for detailed discussion of funding)
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From page 70... ...
. QIO Board Composition, Function, and Structure Consumer Representation on QIO Boards The boards of the 41 organizations holding QIO core contracts surveyed for this study vary considerably in size and are heavily dominated by physicians and other clinicians and providers (see Chapter 7 for further discussion of QIO boards and their membership)
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From page 71... ...
The committee found that physicians dominated nearly all the QIO boards, that two-thirds of all board members listed in the IOM's webbased data collection tool were physicians, and that all responding QIO CEOs (39 of 41) listed representatives of office-based practices on their boards.
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From page 72... ...
Limited Competition The committee finds that few entities other than out-of-state QIOs have been serious competitors for QIO core contracts in the past or are expected to compete for the 8th SOW, given the wide and complex assortment of required tasks and structural requirements. Other entities that are not physician-access or physician-sponsored organizations might have the capacity to perform all or portions of that contract (see Chapter 3 for further discussion of "other entities")
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From page 73... ...
The potential for such conflicts appears less likely now, however, given the decreased emphasis on case review and sanctions since the early days of the Professional Standards Review Organization program. There is clearly a market demand for the additional services of some QIOs, and under its current level of funding, the Medicare QIO program is unlikely to meet fully the future need for technical assistance with quality improvement.
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From page 74... ...
OVERSIGHT OF THE QIO PROGRAM3 CMS has the challenge of managing the QIO program in the field, as well as integrating it into the operational responsibilities of the Medicare program. The main oversight functions required of the CMS Quality Improvement Group, which runs the QIO program, include the following: · Operation of complex data processing and communications systems for the program · Management and evaluation of QIO core contracts and contracts for QIOSCs, special studies, and support contracts · Strategic planning needed to ensure the continued usefulness of the QIO program to the Medicare program Chapter 13 describes the various communications and management mechanisms used by the QIO program and its data systems.
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From page 75... ...
The Standard Data Processing System supports the communications tools mentioned above, as well as the flow and processing of data from medical records. It is key to the QIO program, and 63 percent of the QIOs rated the value of the system as excellent or good, although some QIOs mentioned the need to update the system and integrate it with their own equipment.
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From page 76... ...
. The committee recognizes, however, that full implementation of both electronic health records and the new national public reporting system will take time.
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From page 77... ...
Although many of the support contracts are related tangentially to the QIO program, QIOs may be unaware of those contracts or of a special study that is under way and would be of interest to them. CMS is in the process of developing a management and accountability plan to better administer all of its contracts.
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From page 78... ...
This management structure could give the QIO program an opportunity to integrate its activities with those of other CMS functions, such as public reporting, in the early planning stages. The council has adopted a vision of the QIO program -- "the right care for every person every time"-and has made it the vision of the whole agency.
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From page 79... ...
SUMMARY While there is evidence that the quality of care for Medicare beneficiaries has been improving, the evidence concerning specific quality improvement efforts, the overall impact of individual QIOs, and the impact of the QIO program in the aggregate is limited and inconclusive. Nevertheless, the committee considers the QIO program to be a potentially rich resource as the health care system moves toward the increased use of performance measurement and pay for performance.
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From page 80... ...
2004. The Quality Improvement Organization Program: CMS Briefing for IOM Staff.
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From page 81... ...
2005. QIO Program: Update and Policy Considerations.
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