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Focus on QIO's Medicare Quality Improvement Organizations, 2005-2008 By Margaret LeDuc, Communications Specialist, Medicare Quality Improvement Organizations (QIOs) work in partnership throughout the healthcare system with physicians, hospitals, nursing homes, and home health agencies to improve the quality of healthcare delivered to Medicare beneficiaries. The Medicare program contracts with one organization in each state to serve in this capacity; Stratis Health serves as the QIO for Minnesota. QIOs in each state collaborate with healthcare professionals to examine their practices and improve systems of providing care. They provide free education based on proven best practices to help ensure that care is safe, effective, timely, patient-centered, efficient and equitable. QIOs measure healthcare quality using widely accepted clinical indicators – like the number of minutes it takes to administer certain drugs to heart attack patients or the percentage of people with diabetes who get regular retinal eye exams. The QIOs’ Charge in the 8th Statement of Work: The QIOs’ 8th three-year contract, or Statement of Work, with Medicare began in August 2005. The Centers for Medicare & Medicaid Services (CMS) is challenging QIOs to work with providers to achieve “transformational change” in healthcare, and to deliver the right care for every person every time. They will employ four strategies to help providers transform the care they deliver: • Measuring and reporting performance: Reporting helps providers to identify opportunities for improvement, to track the progress of their changes and to compare their performance against others. • Adopting and effectively using information technology: Research strongly suggests that technologies such as electronic medical records, computerized physician order entry systems and medication barcodes reduce errors and assist providers in making appropriate point-of-care decisions. QIOs will help providers select and best use these tools to improve patient outcomes. • Redesigning care processes: QIOs will assist the healthcare community in placing patients at the center of their own care. These changes will eliminate redundancies in care, allowing the system to redirect resources to areas requiring extra support. • Changing organizational cultures: QIOs will work with providers to foster an environment where senior leaders orient teams to quality through specific goals and performance assessment; where employees are empowered to look for potential problems and immediately fix mistakes;and where management teams that effectively recruit and promote successful teamwork continually seek to clarify roles and learn from past experiences. During the next three years, QIOs will work with providers in each setting to improve care in the following areas: Hospitals: Quality improvement work in hospitals will focus on computerized physician order entry (CPOE), medication barcoding, telehealth, and quality measurement reporting. The clinical areas of focus will include acute myocardial infarction, heart failure, pneumonia, and surgical care. In addition, under the Hospital Payment Monitoring Program, projects will be conducted to decrease payment errors, improve billing and payment documentation, and address risk assessment. Work in rural and critical access hospitals will concentrate on patient safety, quality measurement reporting, and the clinical areas of acute myocardial infarction, heart failure, and pneumonia. Physician Practices: The three major areas of focus for physician practices will be 1) adoption and implementation of electronic health records and care process redesign; 2) adoption and use of culturally and linguistically appropriate service standards for underserved populations; and 3) safety in delivery of prescription drugs, including use of e-prescribing, registries, and medication therapy management services. QIOs also will support improvement in preventive care in the clinic for patients with diabetes, breast cancer screening, and adult immunization. Nursing Homes: Nursing home quality improvement work will address resident and employee satisfaction, staff turnover, and setting targets for quality improvement. The clinical areas of focus will include pressure ulcers, pain management, physical restraints, and depression. Home Health Agencies: In home health agencies, QIOs will support improvement efforts related to telehealth technologies and culture change, with a clinical focus on reducing acute care hospitalizations, managing oral medications, and promoting influenza and pneumococcal immunization. Provider and Consumer Resources As part of its Medicare work, QIOs refer providers and consumers to online healthcare quality improvement resources. One of those resources, MedQIC (www.medqic.org), provides interventions that can change processes and behaviors in healthcare settings, with tools, literature, and success stories that clinicians can use to review and implement in their own quality improvement efforts. QIOs also partner with providers to report information on their quality of care. There are tools available to help consumers compare quality at www.medicare.gov, or by calling 1-800-MEDICARE (800-633-4227). The tools show how often hospitals, home health agencies, nursing homes, and dialysis facilities give their patients the right care at the right time. This information can be used by consumers when they are talking to a health care professional about their care needs. QIOs also provide a helpline and an appeals and mediation process for beneficiaries that addresses appropriate care, appropriate care setting, notices of non-coverage, documentation, and billing. Contact Stratis Health at 952-854-3306 or info@stratishealth.org.
It is important that all members of MHQP know you are invited to attend Board Meetings. If you have questions, feel free to contact the Board Members.
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Copyright © 2005 Minnesota Healthcare Quality Professionals |
