Overview of the Medicare QIO 9th Statement of Work SoW9

1
Overview of the Medicare QIO 9th Statement of
Work (SoW9)

• Home Health Statewide Meeting
• Thursday June 5, 2008
• Macon State College
• Material shared by the
• American Health Quality Association (AHQA)

2
Objectives

• Obtain an overview of the 9th SOW for the Quality
  Improvement Organizations
• Identify the opportunities for home health
  agencies to continue their collaboration with the
  QIO
• Think ahead to potential health care quality
  improvements for the person in the continuum of
  care

3
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

4

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.

5
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

6
What QIOs do

• Work with national associations and support the
  national campaigns (e.g., Home Health ACH
  Campaign and the ReACH Collaborative) to motivate
  and support providers
• For example - QIOs began working nationally with
  home health providers in 2002, with mutually
  beneficial results

7
(No Transcript)
8
(No Transcript)
9
CMS Contract Requirements

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

10
Medicare QIO 9th 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

11
Medicare QIO 9th 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

12
(No Transcript)
13
Medicare QIO 9th Statement of Work built on 4
Themes

• Beneficiary Protection
• Care Transitions (Patient Pathways)
• Patient Safety
• Prevention

14
8th SOW vs. 9th SOWMajor Differences

• 9th SOW
• Themes that cross settings
• Some National some
• Sub-National
• Includes Outcomes

• 8th SOW
• Specific Settings
• All projects National
• Predominantly
• Processes of Care

15
Beneficiary Protection

• Mandated review activity in all settings
• Increase analysis of the quality improvement
  needs for system wide changes
• Identify any disparities in care
• Collaborate with all CMS contractors

16
QIO 9th 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
  may include home health agencies

17
(No Transcript)
18
(No Transcript)
19
QIO Work to Improve Care Transitions

• Competitive QIO proposals will be funded in a
  dozen or so communities beginning in August 2008
• Modeled on an 8th Statement of Work Special
  Project led by the Colorado Foundation for
  Medical Care (CO QIO)
• Flexibility allowed basic model is for QIOs to
  assemble providers to cooperate on improving care
  transitions hospital, nursing home, home health
  agency, physician office, and pharmacy to reduce
  unnecessary acute-care hospitalizations and
  improve the management of oral medications

20
QIO 9th Statement of Work Care Transitions (10
measures)

• 4 types of re-hospitalization rates
• 2 patient assessments 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

21
Care Transitions Work Linked to Deficit Reduction
Act of 2005

• Congress instructed CMS to
• Develop a uniform assessment instrument to
  measure and compare Medicare beneficiaries
  health and functional status across provider
  settings, over time
• Test the instruments usefulness in a 3-year
• Post- Acute Care Payment Reform Demo
• starting 2008
• QIOs will be trained in use of the CARE Tool

22
(No Transcript)
23
Patient Safety Theme

• Also known as the CMS National Patient Safety
  Initiative or NPSI
• Addresses areas of patient care for which there
  is evidence of how to improve health care
• Addresses processes and systems
• Builds on the work of the past 3 years

24
QIO 9th Statement of WorkPatient Safety (6
measures)

• Reducing pressure ulcers in nursing homes and
  hospitals
• Reducing physical restraints in nursing homes
• Improving inpatient surgical safety and heart
  failure treatment in hospitals
• Reducing rates of MRSA in hospitals
• Improving drug safety in all provider settings
  including home health
• Assistance with nursing homes in need

25
Establishment of Provider Pools

• CMS response to target providers who help
• Focuses on assistance to facilities with the
  Greatest Opportunity for Quality Improvement
• Applies to all QIO work except MRSA, Drug Safety,
  and Nursing Homes in Need
• CMS determined the provider pools, but the QIO
  has option to recruit some additional providers
• CMS published these lists in February

26
(No Transcript)
27
Tools available for providers

• Survey instruments for leadership
• TeamSTEPPS training
• Technical assistance
• Partnerships with others campaigns,
  collaboratives, cross setting meetings to reduce
  pressure ulcers

28
Prevention

• Goal is to improve the quality and frequency of
  preventive health care services in order to
  optimize beneficiary quality of life and health
  care efficiencies
• Three areas of focus Core Prevention,
  Diabetes Disparities and Chronic Kidney Disease
  (CKD)

29
9th Statement of Work Prevention (10 measures)

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

30
Core Prevention

• Mammography
• CRC Screening
• Influenza Vaccination
• Pneumococcal Pneumonia Vaccination

31
(No Transcript)
32
(No Transcript)
33
(No Transcript)
34
Next Steps LOGIC Models

• Begin with the end in mind
• Framework for theme planning
• One element of the IQC Plan
• Completed with the QIO Team Members
• Reviewed with Stakeholders and Advisory Board
  Members for support with activity planning

35
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

36
Questions?

• Linda Kluge, RD, LD, CPHQ
• lkluge_at_gmcf.org

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 do not necessarily reflect CMS
policy. Publication No.
8SOW-GA-HH-08-07