The Rationale for Working with QIOs

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The Rationale for Working with QIOs

• Overview of the CMS Medicare QIO
• 9th Statement of Work (SoW9)
• September 2008
• Georgia Hospital Association TELNET Presentations
• Material shared by the
• CMS and American Health Quality Association (AHQA)

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Objectives

• Give a clear understanding of the 9th SOW and the
  Patient Safety Theme
• Outline benefits of participation with GMCF for
  the Patient Safety Theme
• Gain ideas on how to develop a standardized
  approach to working with QIOs
• Understand the value of collaboration

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Medicare Quality Improvement Organizations

• Congress created the Medicare QIO program in 1982
• Largest federal investment in health care quality
  improvement
• Implemented by private organizations, the QIOs
• QIOs are working with thousands of health care
  professionals in 53 states and territories
• GMCF has been the QIO (PSRO originally) in
  Georgia since 1978

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Medicare Quality Improvement Organizations

• QIOs are staffed by nurses, physicians,
  biostatisticians, epidemiologists, health care
  administrators, quality and communications
  professionals.
• Every 3 years, CMS launches a new Statement of
  Work with new assignments for QIO contractors.

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What QIOs do

• Promote awareness of opportunities to improve
  care quality.
• Encourage providers to focus on problems and
  causes using quality measures, chart reviews and
  clinical guidelines.
• Help providers self-assess performance and design
  clinical process changes.

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What QIOs do

• Work with national associations and support the
  national campaigns (e.g., IHI 5M Lives Campaign
  and the Advancing Excellence Campaign) to
  motivate and support providers.
• For example - QIOs began working nationally with
  nursing home providers in 2002, with mutually
  beneficial results.

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Nursing homes are improving carewith QIO
assistance
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Nursing homes are improving carewith QIO
assistance
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CMS Contract Requirements

• Information Technology
• Reporting Processes
• Confidentiality
• Data Usage
• Stakeholder Partnerships
• Communication
• Publications
• Education, Information and Outreach
• Internal Quality Control
• Evaluation

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9th Medicare QIO Statement of Work CMS Goals

• QIOs are to improve quality of care for
  beneficiaries by
• Helping providers
• Preventing illness
• Decreasing harm to patients
• Reducing waste in health care

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9th Medicare QIO Statement of Work CMS
Patient-centered Objectives

• 245,000 more patients screened for Chronic Kidney
  Disease
• 39,616 fewer Pressure Ulcers in nursing homes
• 3,687 fewer Pressure Ulcers in hospitals
• 23,610 fewer Physical Restraints in nursing homes
• 7,875 fewer antibiotic-resistant infections
• 14,252 lives saved from postoperative
  complications in hospitals

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9th Medicare QIO Statement of Work built on 4
Themes

• Beneficiary Protection
• Patient Safety
• Prevention Core, Diabetes, CKD
• Care Transitions (Patient Pathways)

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9th Medicare QIO Statement of WorkBeneficiary
Protection (4 measures)

• Timely completion of case reviews
• Beneficiary satisfaction with complaint process
• Completion of satisfaction survey
• Quality Improvement Activity (QIA) completion

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9th Medicare QIO Statement of WorkPatient
Safety Theme

• SCIP/HF - Hospitals
• Pressure Ulcers - Hospitals and Nursing Homes
• Physical Restraints - Nursing Homes
• MRSA - Hospitals
• Drug Safety
• Nursing Homes in Need

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Establishment of Provider Pools

• CMS response to target providers who help
• Based on public measures from 2006-2007
• Focuses on assistance to facilities with the
  Greatest Opportunity for Quality Improvement
• Applies to all QIO work except MRSA, Drug Safety,
  
• and Nursing Home in Need Providers.
• CMS determined the provider pools, but the QIO
  has option to recruit some additional providers.
• CMS published these lists in February 2008.

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9th Statement of Work Prevention (10 measures)

• Core
• Mammography
• CRC Screening
• Influenza Vaccination
• Pneumococcal Pneumonia Vaccination
• Diabetes Disparities 12 counties in Georgia
• HbA1c rates
• Lipid examination rates
• Eye exam rates
• Chronic Kidney Disease (CKD) Quality Initiative
• Screening for nephropathy
• ACE/ARB therapy to prevent progression
• AV Fistula rate (new dialysis pts)

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9th Statement of Work Care Transitions (10
measures)

• 4 types of re-hospitalization rates
• 2 pt assessment of hospital discharge performance
  (H-CAHPS)
• 1 physician visit post discharge, before
  re-admission (within 30 days)
• 2 measures with CARE instrument
• 1 measure of adoption of interventions
• In Gwinnett, Rockdale and Newton Counties

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Patient Safety Theme

• We are all working toward
• Freeing patients from the risk of harm, injury,
  or loss resulting from their interaction with the
  health care delivery system
• Setting the standard for our nations health care
  delivery system

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Benefits of Participation

• Professional Quality Improvement technical
  assistance from GMCF, the Quality Improvement
  Organization (QIO) in Georgia
• Data collection support
• Tools to improve communication among staff
  resulting in a more positive patient experience
  and greater employee satisfaction
• Tools to improve communication within our local
  quality improvement communities
• Access to tools, patient safety affiliates,
  resources, and successful interventions
• Recognition of successes at a local and/or
  national level

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SCIP/HF Agreement

• Commit to improving quality of care related to
  SCIP/HF in your facility by committing to patient
  safety and through education of clinical
  providers and health care leaders
• Track incremental changes in quality measures
  that lead to big results within our facility and
  will share our knowledge base with others in the
  patient safety community
• Seek opportunities for synergy with other
  participants in this component to reach and
  surpass goals set in the 9th SOW
• Facilitate continuous quality improvement through
  sharing intervention tools and information on
  effective methods for improving processes and
  outcomes with peers
• Contribute organizational resources as
  appropriate and according to the strengths of our
  organization in an effort to improve quality of
  care received in our facility

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Hospital Pressure Ulcer

• Commit to improving quality of care related to
  Hospital Pressure Ulcers in our facility by
  committing to patient safety and through
  education of clinical providers and health care
  leaders
• Track incremental changes in quality measures
  that lead to big results within our facility and
  will share our knowledge base with others in the
  patient safety community
• Seek opportunities for synergy with other
  participants in this component to reach and
  surpass goals set in the SOW
• Facilitate continuous quality improvement through
  sharing intervention tools and information on
  effective methods for improving processes and
  outcomes with peers
• Collect and share data using data collection
  tools aligned with this component
• Contribute organizational resources as
  appropriate and according to the strengths of our
  organization in an effort to improve quality of
  care received in our facility.

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Nursing Home Pressure Ulcer

• Commit to improving quality of care related to
  Nursing Home-Pressure Ulcer in our facility by
  committing to patient safety and through
  education of clinical providers and health care
  leaders
• v   Track incremental changes in quality measures
  that lead to big results within our facility and
  will share our knowledge base with others in the
  patient safety community
• v   Seek opportunities for synergy with other
  participants in this component to reach and
  surpass goals set in the SOW
• v   Facilitate continuous quality improvement
  through sharing intervention tools and
  information on effective methods for improving
  processes and outcomes with peers
• v   Collect and share data using data collection
  tools aligned with this component
• v   Contribute organizational resources as
  appropriate and according to the strengths of our
  organization in an effort to improve quality of
  care received in our facility.

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MRSA

• v    Commit to improving quality of care related
  to MRSA in our facility by committing to patient
  safety and through education of clinical
  providers and health care leaders
• v   Track incremental changes in quality measures
  that lead to big results within our facility and
  will share our knowledge base with others in the
  patient safety community
• v   Seek opportunities for synergy with other
  participants in this component to reach and
  surpass goals set in the SOW
• v   Facilitate continuous quality improvement
  through sharing intervention tools and
  information on effective methods for improving
  processes and outcomes with peers
• v    Collect and share data using data collection
  tools aligned with this component including the
  HLQAT, the AHRQ Patient Safety Culture Survey and
  the NHSN
• v   Share related data with GMCF and its support
  contractor.
• v   Contribute organizational resources as
  appropriate and according to the strengths of our
  organization in an effort to improve quality of
  care received in our facility.
• Participate in TeamSTEPPS training.

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Thoughts on Collaboration

• There is no limit to what a man can do or where
  he can go
• if he doesnt mind who
• gets the credit.
• Robert Woodruff

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GMCF Patient Safety Theme Team

• Linda Kluge, Director, QIO lkluge_at_gmcf.org
• Dr. Kimberly Rask, Medical Director krask_at_emory.ed
  u
• Dr. Herbert Karp, Medical Director hkarp_at_gmcf.org
  
• Sheryl Allen, Quality Advisor sallen_at_gmcf.org
• Melody Brown, Quality Advisor mbrown_at_gmcf.org
• Mary Ellen Elmore, Quality Advisor melmore_at_gmcf.or
  g
• Robbie Lane, Quality Advisor rlane_at_gmcf.org
• Carolyn Roper, Quality Advisor croper_at_gmcf.org
• Gaetane Wilder, Quality Advisor gwilder_at_gmcf.org
  
• Tracy Rutland, Education Specialist trutland_at_gmcf.
  org
• Robby Langston, Data Analyst rlangston_at_gmcf.org
• Rachel Fomby, Administrative Assistant rfomby_at_gmcf
  .org

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Questions?
Signed Agreements must be faxed to GMCF at
678-527-3030 no later than September 26 for
those wishing to participate in the Patient
Safety Theme Activities. Please join us in this
new work!

• This material was prepared by GMCF, the Medicare
  Quality Improvement Organization for Georgia,
  under contract with the Centers for Medicare
  Medicaid Services (CMS), an agency of the U.S.
  Department of Health and Human Services. The
  contents presented to not necessarily reflect CMS
  policy. Publication No. 9SOW-GA-PSF-08-13