Medicare's Quality Improvement Organization Program Maximizing Potential (2006) / Chapter Skim
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3 Performance Measurement, Quality Improvement, and Other Entities
3 Performance Measurement, Quality Improvement, and Other Entities
Pages 82-101
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From page 82... ...
The committee believes examining a program's past is of particular value in considering changes that should be made in the future. It should also be noted that the committee's judgments about future roles for the QIO program are based on certain expectations regarding the changing health care environment.
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From page 83... ...
For example, those used in the QIO program are generally consistent with some of the common measure sets, and the Centers for Medicare and Medicaid Services (CMS) has been collaborating with the relevant associations to eliminate the slight differences in specifications among measures used for
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From page 84... ...
, to be housed as an independent entity within DHHS. This recommendation reflects and builds upon a history of earlier efforts to establish a national performance measurement and public reporting system, including recommendations of the Strategic Framework Board and the Advisory Council for Health Care Quality.
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From page 85... ...
Quality oversight organizations should be able to use these data in their accreditation and certification activities. Performance data should also support decisions on the quality improvement interventions to be undertaken in provider settings.
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From page 86... ...
The NQCB could begin by endorsing a minimum set of such measures for use by all providers in ambulatory care, acute care, health care plans, and long-term care settings; for the treatment of end-stage renal disease; and for longitudinal measurement of health outcomes and health care costs for a given condition or patient. To this end, the committee identified a starter set of measures drawn from current leading measure sets developed or used by such programs as the End Stage Renal Disease program in Medicare; the Leapfrog Group; the Agency for Healthcare Research and Quality's National Quality and Disparities Reports; the Ambulatory care Quality Alliance; the National Committee for Quality Assurance's Health Plan Employer Data and Information Set (HEDIS)
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From page 87... ...
SOURCE: Performance Measurement: Accelerating Improvement, adapted from Strategic Framework Board (McGlynn, 2003)
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From page 88... ...
TABLE 3.1 Gaps in Current Performance Measure Sets Relevant Design Gap Principles Description Limited scope of measurement: Principle 1: A performance measurement Few measures of patient-centered Comprehensive system should advance the core care, equity, or efficiency. Few measurement purpose of the health care system measures for children or those at and foster improvements in all six the end of life.
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From page 89... ...
The committee does not specify in detail the activities to be conducted or coordinated by the NQCB. Many of these activities are ongoing under the direction or operation of various public and private organizations across the country, including the QIO program.
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From page 90... ...
FUNCTIONS OF THE NATIONAL QUALITY COORDINATION BOARD AND IMPLICATIONS FOR QIOS This section reviews the various functions likely to be carried out in some fashion by the NQCB and the national system for performance measurement and reporting it establishes, potential contributions of the QIO program, and possible roles for other organizational options and other entities. The discussion here is based on the committee's recommendations in its first report, but goes further to encompass quality improvement efforts as well.
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From page 91... ...
The potential of the QIO program's coordination with Medicaid within CMS has yet to be realized.
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From page 92... ...
, and diminish the potential support and guidance of the NQCB. The next issue the committee addressed was whether it would be better to allow the NQCB to manage the QIO program directly.
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From page 93... ...
Coordination between the NQCB and the QIO program should therefore be explored to the extent that it can advance the goals and priorities of all these organizations. For example, such coordination could lead to more direct links between private-sector and QIO efforts.
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From page 94... ...
The committee then considered whether the QIO program should continue with its current contractors, many of which have held QIO core contracts for multiple scopes of work (SOWs) , or other entities should become eligible bidders.
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From page 95... ...
Thus, the committee envisions the QIO program as providing QIO core services in each state through contracts with the best-qualified organization bidding on each state's contract. Given the committee's recommendations in the following two chapters that include eliminating QIO requirements for physician access or sponsorship, changing board representation, and limiting QIO functions, other entities in addition to organizations currently serving as QIOs might be expected to be well positioned to bid on the core contracts.
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From page 96... ...
Contracts for other functions not part of the core contract in each state likewise might attract bids from some QIOs and other entities. Finally, certain functions might appropriately be funded by the QIO program from its Medicare apportionment at the national level.
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From page 97... ...
Whether one or more data repositories will be needed has yet to be determined. Currently, the QIO program supports a private data repository that serves the needs of the QIOs as well as those of the Hospital Quality Alliance's public reporting program (see Chapter 11 for more detail on public reporting of data)
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From page 98... ...
Many providers also rely on internal quality improvement staff and other organizations to assist with quality improvement efforts, and are more likely to use those resources once public reporting and payment incentives become more common. · Promotion of population health -- In their core contracts, the QIOs have had responsibility for promoting some activities at the provider level to improve the health of populations, and this responsibility continues in the 8th SOW.
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From page 99... ...
One organization suggested as an obvious "other entity" that could operate the QIO program is the Institute for Healthcare Improvement. However, the institute's business model does not appear to be suited to the expanded growth necessary for this organization to provide direct services within each state; rather, its management prefers to work through the QIOs to extend the organization's impact.
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From page 100... ...
On the basis of the committee's perception of the history of the QIO program, its findings and conclusions about the program's current operations, and its view of a future health care system that includes a national performance measurement and reporting system and performance incentives, recommendations for the QIO program are offered in the next two chapters. Chapter 4 focuses on the QIOs' key tasks, and Chapter 5 on how
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From page 101... ...
2006. Performance Measurement: Accelerating Improvement.
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