Quality improvement organizations involved in CMS' Quality Innovation Network claim recent funding cuts are forcing them to significantly reduce staff and prevent them from fulfilling new obligations amid the COVID-19 pandemic.
CMS awarded the 12 quality improvement organizations about $270.1 million over five years in November after a four-month delay in funding. The new funding stream is roughly 60% less than the previous five-year contracts, which has led QIOs to lay off about 40% of their staff and curtail their work, according to Alison Teitelbaum, executive director of the American Health Quality Association, which represents the quality improvement organizations.
It's unclear why the CMS-awarded contracts were smaller this cycle but the agency has continued to call on the quality improvement organizations during COVID-19. Just last week, CMS announced that quality improvement organizations will help nursing homes in COVID-19 hot spots, deploying staff to guide nursing homes on practices to prevent disease spread.
CMS has indicated on calls with QIOs that no additional funding will be provided for this new effort, Teitelbaum said.
"Everyone was shouldering on until the new contracts were awarded and then when it came out that it was so decreased, it further crippled the QIO infrastructure," she said. "You have regional offices closing, you have even more layoffs and furloughs."
The quality improvement organizations are urging CMS to provide more funding. The QIOs have been in communication with CMS, letting officials know "if you don't give us any more money, we are only going to be able to help X number of homes. The more and more in-person, technical assistance we provide, the fewer homes we are going to be able to help," Teitelbaum said.
CMS in April awarded the QIOs an additional $13 million in funding over four years related to helping nursing homes implement infectious disease protocols, but Teitelbaum said additional funding should be provided to accomplish the new task of helping nursing homes in COVID-19 hot spots.
"Fewer people are able to do this, there has been no decrease to this work, and now we have this pandemic," she said. "It's just devastating."
In a statement, a CMS spokeswoman said funding for QIOs have changed beginning with this new contract cycle. Rather than a large contract in the beginning of the cycle, CMS is now funding QIOs by distributing funds over time as work is completed. So far, just one contract has been awarded for this five-year contract period and it focuses on quality in nursing homes. "Other contracts are currently going through the procurement process. CMS does not discuss contract awards and associated funding while the procurement process is active," the spokeswoman said in an email.
The Quality Innovation Network-Quality Improvement Organizations is a federally mandated program that is nearly 50 years old. The organizations have historically worked with hospitals, outpatient clinics, nursing homes and home health organizations throughout the U.S. on initiatives to improve patient care and safety for Medicare beneficiaries. CMS recently changed the focus of QIOs to target providers in small, rural and vulnerable areas that perform poorly on quality measures and have few resources. There is also now a heightened emphasis for QIOs to focus on nursing homes, the agency spokeswoman said. During this pandemic, QIOs help nursing homes on-site or virtually with quality improvement initiatives and expertise.
Correction: This article previously misstated how much CMS cut quality improvement organizations' funding.