CMS is restructuring the Quality Improvement Organization (QIO) Program. This will allow two Beneficiary and Family Centered Care (BFCC) QIO contractors to support the program’s case review and monitoring activities separate from the tradition quality improvement activities of the QIOs.
The two BFCC QIO contractors are Livanta LLC, in Annapolis Junction Maryland and KePRO located in Seven Hill Ohio. There will be responsible for ensuring consistency in the review process along with consideration of local factors. QIOs historically have provided numerous quality improvement functions that include an infrastructure for national quality improvement initiatives across the continuum of care.
CMS’ intent is to restructure the QIO program to gain efficiencies to eliminate any perceived conflicts of interest and to better address the needs of Medicare beneficiaries using BFCC contractors. QIOs are going to focus on providing a patient voice through conducting quality of care reviews, discharge and termination of service appeals, and other areas of required review in various provider settings.
In the program’s second phase expected in July, CMS will award contracts to organizations that will directly work with providers and communities on data-driven quality initiatives to improve patient safety, reduce harm, and improve clinical care and transparency at local, regional, and national levels through Quality Innovation Network and Value Incentive and Quality Reporting support contractors.
CMS will introduce the program changes with the beginning of its five year 11th Statement of Work. Quality Improvement Organizations that have proven successful during the current contract covering the 2011-2014 period.
So far, nursing homes have been able to achieve a 34 percent reduction in pressure ulcers among residents, prevented potential adverse drug events with more than 44, 000 such events avoided, contributed to a 53 percent reduction in hospital infections, and saved more than 100,000 people from being admitted or readmitted to a hospital. This has resulted in improved coordination of care and nearly one billion dollars in savings, although the savings that are estimated are not solely attributable to QIOs.