Eli's Hospice Insider

Published on Mon Aug 18, 2014 PDF

Only 2 QIOs will perform medical review.

Heads up: You may have a new Quality Improvement Organization with which to work.

The Centers for Medicare & Medicaid Services has awarded additional contracts as part of restructuring the Quality Improvement Organization (QIO) Program, CMS says in a release. “The new contracts being awarded to fourteen organizations represent the second phase of QIO restructuring,” the agency explains. “The awardees will work with providers and communities across the country on data-driven quality initiatives.”

New acronym: “These QIOs will be known as Quality Innovation Network (QIN)-QIOs,” CMS adds in the statement.

The first phase of the restructuring allows two Beneficiary and Family-Centered Care (BFCC) QIO contractors to perform the program’s case review and monitoring activities separate from the QI activities performed by QIN-QIOs, CMS says. The two BFCC-QIO contractors are Livanta and KePRO. “They will be responsible for ensuring consistency in the review process with consideration of local factors important to beneficiaries,” CMS says.

This brings the number of QIOs that handle review from 52 to two, points out BKD’s Suzy Harvey in an analysis of the revision. The change is “an effort to remove the appearance of conflict of interest,” Harvey says. With the move, CMS has separated medical review from QI activities.

Strategic initiatives the QIN-QIOs will work on include, reducing readmissions and medication errors, 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, and improving patient and family engagement, CMS says.

Note: Check out your state’s QIO in the chart in CMS’s release at www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2014-Press-releases-items/2014-07-18.html.