Medicares quality improvement organizations will more closely scrutinize specific hospitals surgical prowess as they begin their ninth contract under the gun from the CMS to prove their worth as quality inspectors.
Under the new contract, QIOs will be required to conduct 85% of their work in certain quality measures with 4,000 hospitals and nursing homes identified by the CMS as needing to improve in those areas. The hospitals were targeted for improvement in their surgical-care measurements, and nursing homes will have to improve pressure ulcer rates and reduce the use of physical restraints.
The list was released along with the statement of work during a Feb. 5 news conference. The CMS was hosting a conference call Feb. 8 for those facilities that appeared on the list to answer any questions about why they were targeted, according to a spokesman.
But facilities are questioning whether the list, or the changes to the contract, spells out initiatives that will lead to better quality of care for Medicare beneficiaries.
Its unclear how the changes are going to strengthen the relationship between hospitals and QIOs, said Leigh Hamby, a physician, executive vice president and chief quality officer for Atlanta-based Piedmont Healthcare. The 100-bed Piedmont Fayette Hospital, Fayetteville, Ga., part of the health system, appears on the CMS list.
Seton Health System, Troy, N.Y., which also appears on the list of hospitals targeted for surgical-care improvements, said the data on which the CMS based its measurements are old. We implemented changes immediately and our results have improved greatly ... since they were calculated. We are eager for more current 2007 data to be publicly available, which will confirm these improvements, said Gino Pazzaglini, president and chief executive officer, in a written statement.
The list of facilities is part of the agencys response to criticism from the Institute of Medicine and the Government Accountability Office, both of which reported Medicare was not efficiently managing QIOs that were not fulfilling contractual obligations to work with healthcare facilities most in need of quality improvements. The CMS said the new statement of work establishes more stringent parameters to track QIOs progress.
Nursing home practitioners are happy about the changes, saying they give greater attention to the areas that facilities are struggling with.
In the past, focus on nursing homes varied from state to state, based on that QIOs priorities, said Larry Minnix, president and CEO of the American Association of Homes and Services for the Aging. This ninth statement of work is going to make all of us work together, he said.
The Advancing Excellence in Americas Nursing Homes campaign, founded in part by the AAHSA, said the changes are in tune with the campaigns goals of reducing pressure ulcers and the use of restraints.
The IOM report identified areas that were very problematic for us, said Mary Jane Koren, chairwoman of the campaign steering committee.
One of the biggest differences in the new contract is the approach QIOs will have to take in working with various healthcare facilities, she said. Starting in August, there will be more cross-facility collaboration, such as between nursing homes and hospitals, to improve patient transitions. Patients move between these settings, Koren said. The past silo approach, in which QIOs did not usually talk to all facilities regarding one patient seeking care at each, was not effective to overall quality improvement, she said.
Details of the new statement of work were released last week as the 53 QIOs currently contracted under the old three-year agreement begin to draft proposals that will ensure they can continue to operate under the new agreement. QIOs have until Feb. 25 to submit their plans, and the new three-year contract begins Aug. 1.
QIOs do not automatically receive new contracts every three years, but they do have an easier time in the bidding process if theyve reached the goals listed under the old statement of work. The CMS said eight QIOs did not meet requirements under the contract ending this year and will be required to compete against other organizations in those statesCalifornia, Minnesota, Mississippi, Nevada, New York, North Carolina, Oklahoma and South Carolinawishing to work with Medicare.
But even QIOs in good standing will have to work harder this year on their proposals. QIOs will have to submit detailed, well-thought out proposals that show they understand what the CMS hopes to accomplish under the new contract if they want to keep their designation, said H. John Keimig, president and CEO of Quality Partners of Rhode Island, that states QIO. The CMS wants to demonstrate the QIO program is successful. Theyre really stressing attribution this year, he said.