cms quality improvement program

CMS Launches Next Phase of New Quality Improvement Program

On July 18, CMS awarded additional contracts as part of a restructuring of the Quality Improvement Organization (QIO) Program to create a new approach to improve care for beneficiaries, families and caregivers. QIOs are private, mostly not-for-profit organizations staffed by doctors and other health care professionals trained to review medical care and help beneficiaries with complaints about the quality of care and to implement improvements in the quality of care available throughout the spectrum of care. The new contracts being awarded to fourteen organizations represent the second phase of QIO restructuring. The awardees will work with providers and communities across the country on data-driven quality initiatives. These QIOs will be known as Quality Innovation Network (QIN)-QIOs.

QIN-QIO projects will be based in communities, health care facilities and clinical practices. They will drive quality by providing technical assistance, convening learning and action networks for sharing best practices, collecting and analyzing data for improvement. HHS National Quality Strategy (NQS) and the CMS Quality Strategy provide the framework for the contracts along with the companion, recommendations, and priorities.

Specifically, each QIN-QIO will work on strategic initiatives such as reducing healthcare associated infections, reducing readmissions and medication errors, working with nursing homes to improve care for residents, supporting clinical practices in using interoperable health information technology to enable the exchange of essential health information to improve the coordination of care, promoting prevention activities, reducing cardiac disease and diabetes, reducing health care disparities and improving patient and family engagement. QIN-QIOs will also provide technical assistance for improvement in CMS value based purchasing programs, including the physician value based modifier program.

As a result of the changes, some hospitals and providers will now work with a different QIO than in the past. The new QIN-QIO contracts were competitively awarded. The restructured program will continue to ensure that the entire country participates in strategic initiatives and that local practices are considered. The first phase of the restructuring – which CMS announced on May 9, 2014 –allows two Beneficiary and Family-Centered Care (BFCC) QIO contractors to perform the program’s case review and monitoring activities separate from the quality improvement activities performed by QIN-QIOs. CMS will introduce the program changes with the beginning of its five year, 11th Statement of Work – the QIO contracts cycle – on August 1, 2014.

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