Medicare's quality improvement organizations will use information technology to better track hospital progress, as well as their own, as they begin their ninth contract under the gun from the CMS to prove their worth as quality inspectors.
Details of the new statement of work were released Feb. 5 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 they've reached the goals stated 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, North Carolina, Nevada, New York, 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 chief executive officer of Quality Partners of Rhode Island, that state's QIO. "The CMS wants to demonstrate the QIO program is successful. They're really stressing attribution this year," he said.
Electronic health records will in part help toward that accountability. The CMS said QIOs will encourage the use of EHRs in physician practices, which will have to report data to ensure they are adhering to national immunization and cancer screening guidelines. The CMS will track patient-safety progress through measures posted on its nursing home and hospital comparison Web sites, as well.
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 of facilities is part of the agency's 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.
But facilities are questioning whether the list or the changes to the contract spell out initiatives that will lead to better quality of care for Medicare beneficiaries.
"It's 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., a 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 CEO, in a statement.
The changes to the statement of work will help those facilities improve faster because it forces the QIOs to concentrate on them, said David Schulke, executive vice president of the American Health Quality Association, which represents the nationwide network of QIOs. Hospitals on the list are more upset about the numbers the CMS used to reach its determination of poor quality, and once the question of the measurement system is solved, QIOs and healthcare facilities can focus on quality issues, he said.
While the new statement of work accomplishes the goal of increasing accountability among QIOs, it doesn't address how the organizations will be able to comply when faced with a shrinking Medicare budget, Schulke said. "It's all good work; it's really, can you continue to demand more for less," he said.
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 QIO's 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 America's Nursing Homes campaign said the changes are in tune with the campaign's 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.
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