Louisiana Health Care Review
THE MEDICARE QUALITY IMPROVEMENT ORGANIZATION
What is a QIO?
Quality Improvement Organization (QIO) Program
What is a Quality Improvement Organization (QIO)?
When the Medicare program originated in the 1960’s through the Social Security Act, Congress identified the need for state organizations to "ensure the quality, effectiveness, efficiency and economy of health care services provided to Medicare beneficiaries." The program consists of a national network of fifty-three QIOs (formerly known as Peer Review Organizations, or PROs) responsible for each U.S. state, territory, and the District of Columbia. Louisiana Health Care Review, Inc. is your QIO in Louisiana.

Who funds the QIOs?
QIOs are funded by the Centers for Medicare & Medicaid Services (CMS, formerly HCFA).

What does the QIO do?
Working with multiple providers in conjunction with national and local organizations, the QIO program has gained experience implementing quality improvement programs with hospitals, nursing homes, home health agencies, managed care organizations, and physicians’ offices. QIOs also serve as advocates for the Medicare beneficiary providing education and handling complaints. QIOs provide technical assistance to Medicare providers by:

  • Facilitating their collection and analysis of data
  • Providing educational programs on quality improvement methodologies
  • Identifying improvement opportunities
  • Sharing valuable resources and best practices within the provider settings

What kind of staff does the QIO have?
Experts in health care quality improvement – physicians, nurses, statisticians, marketing experts, professional educators, health care analysts, epidemiologists and other professionals.

What is CMS’ Nursing Home Public Reporting Quality Initiative?
In November 2001, CMS launched the Public Reporting Quality Initiative for nursing homes. Six states (CO, FL, OH, MD, RI, & WA) were chosen to pilot test the public reporting of 10 quality measures on CMS’ website Nursing Home Compare (http://www.medicare.gov/NHCompare/home.asp). The measures include 3 post-acute measures (pain management, delirium, and walking improvement) and seven chronic care measures (pain management, pressure ulcers, psychotropic drug use, ADL decline, weight loss, infections, and restraints).

Quality measures for nursing homes in all states will be reported beginning in October, 2002. The final set of quality measures to be reported nationally has not yet been determined, but may include none, some or all of the 10 measures from the six-state pilot.

How does the QIO fit in?
The QIOs will provide educational programs and materials to all nursing homes in their states to assist them in understanding the publicly reported quality measures and how they can use this information as a tool to improve the quality of care in their nursing home. The QIOs will also be working with a small group of volunteer nursing homes in each state to pilot test the development and implementation of specific quality improvement projects based on these measures.

Will this cost the nursing homes anything?
No – since QIOs are funded by CMS, there is no cost to nursing homes in this initiative. QIOs are paid to facilitate quality improvement for Medicare providers.

 

 

 


For more Quality Improvement
resources, visit www.medqic.org

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Louisiana Health Care Review, Inc. © 2002-2007
8591 United Plaza Boulevard, Suite 270
Baton Rouge, Louisiana 70809
Telephone: 225-926-6353 / Fax: 225-923-0957