Better public reporting of hospital quality measures is high on the draft agenda of Medicare's newly named quality-improvement organizations.
The QIOs, the new acronym for what once were called peer-review organizations, would conduct pilot studies in a small number of states as a first step toward developing "a national strategy for public reporting by hospitals." The explicit mission is part of a draft document released last week by the Centers for Medicare and Medicaid Services.
The document, known as the 7th Contract Cycle Statement of Work, outlines a three-year workplan to begin in August 2002 for some QIOs. There have been six previous three-year workplans for Medicare's quality overseers.
The new workplan dramatically expands the responsibilities of the QIOs, charging them with improving the quality of care delivered by nursing homes, home healthcare providers and physician offices, in addition to hospitals. Modern Healthcare was first to report that new areas of responsibilities were being proposed for QIOs (Nov. 19, p. 8).
But QIOs' role in monitoring and reducing Medicare payment errors to providers appears to be "very scaled back," said David Schulke, executive vice president of the American Health Quality Association, which represents QIOs. Provider groups have been critical of a CMS program, introduced in 1999, which pays QIOs a bonus for reducing payment error rates in their states.
"We need to do some developmental work before we make any further gains," Stephen Jencks, M.D., the CMS' Quality Improvement Group director, said of the Payment Error Prevention Program. Though QIOs discovered that inappropriate hospital admissions were the major source of payment error, there is a lack of consensus on what constitutes an appropriate or inappropriate admission, Jencks said.
Medicare's 38 regional QIOs now collectively receive more than $300 million annually to fulfill their tasks. The White House Office of Management and Budget is expected to set funding levels for QIOs' new mission this month.
One three-year goal in the draft workplan would be advancing hospitals' capabilities to generate quality-measurement data, such as how much time elapses before pneumonia patients receive the first dose of antibiotics. Such an effort would support work under way by the Joint Commission on Accreditation of Healthcare Organizations and some states that require hospitals to report specific data on patient outcomes.