CMS to restructure QIO program

The Centers for Medicare & Medicaid Services will restructure its Quality Improvement Organization (QIO) program by hiring two contractors to oversee quality improvement measures for Medicare beneficiaries.

Phase one of the restructure will allow two beneficiary and family-centered care QIO contractors--Maryland-based Livanta LLC and Ohio-based KePRO--to review and monitor activities separate from the traditional quality improvement activities of the QIO, according to the announcement. The program uses private companies to review medical care, improve services and help beneficiaries with complaints in an effort to keep costs down while making a network of providers available to Medicare patients.  

In the second phase of the restructure, the agency will award contracts to groups that will work directly with providers to improve patient care.  

The new structure comes after a 2006 report from the Institute of Medicine called for major changes to the program after it found mismanaged resources and potential conflicts of interest with healthcare providers, The Hill reported.

CMS hopes the revisions to the program, which include quality of care reviews, and discharge and termination of service appeals, will make it more efficient, eliminate any perceived conflicts of interest and better address the needs of Medicare beneficiaries.

The American Health Quality Association commended CMS for restructuring the program, which it called vital to the goal of reducing hospital readmissions and improving quality of care. Executive Director Todd Ketch said in the statement that communities where QIOs coordinated interventions to improve Medicare patients' quality of care, the rate of hospital readmissions dropped more than the overall nationwide reduction in readmissions (13 percent compared to 11.68 percent from 2010-2013).

Livanta LLC will work with the states in the Northeast and the Pacific Northwest, along with Alaska, Hawaii and the Virgin Islands, while KePRO will work with states in the South, Midwest and West, according to the announcement.

To learn more:
- here's the CMS announcement
- read The Hill article
- check out the AHQA statement

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