Quality Innovation Network Quality Improvement Organizations' (QIN-QIOs') Benefits to Skilled Nursing Facilities and Physicians

Abstract

The Medicare Quality Improvement Organization (QIO) program is administered through a nationwide network of quality improvement professionals that provide assistance to health care providers to drive improvements and lower cost. The QIO program was organized into 3-year contract cycles beginning in 1988, with contracts being awarded to QIOs by the Centers for Medicare and Medicaid Services (CMS). Under previous CMS contracts, the QIOs undertook both quality improvement and quality assurance (case review) activities. QIOs worked locally with health care providers, consumers, health plans, and other partners to optimize care delivery systems to ensure that patients get the right care at the right time. Recent successes of the QIO program have been in the areas of helping providers to use health information technology in a more effective manner, reducing the rate at which Medicare patients were hospitalized or readmitted within 30 days of discharge, and transforming health care delivery to reduce patient harm and champion patient-centered care. For example, over the past decade, QIOs have had a consistent and productive track record of working with nursing facilities to improve care in the areas of reducing the use of antipsychotic medication, lowering the prevalence of pressure ulcers, and eliminating the use of physical restraints. Recently, CMS redesigned the QIO program, moving from statebased QIO entities to regional QIOs to realize additional operational efficiencies. Moving forward, there will be 2 types of regional QIOs: Beneficiary and Family-Centered Care QIOs will manage all Medicare case review activity, and Quality Innovation Network (QIN) QIOs will perform quality improvement activities. QIN-QIOs began work under new 5-year contracts on August 1, 2014. The new contract period is known as the 11th Statement of Work (SOW) for the QIN-QIO program. During the contract period,