Straightforwardness in the QIO 9 th Scope of Work: Beyond Hospital Compare Nancy Jane C. Friedley, MD Medical Director Delmarva Foundation May 9, 2008
Slide 2Introductions
Slide 3Overview Objectives: 1) Understand the fundamental layout of the QIO ninth SOW 2) Understand the different CMS correlation instruments for straightforwardness 3) Understand the PQRI detailing framework, how it works and why it is imperative to have doctors included
Slide 4Transparency in the QIO 9 th Scope of Work: Outline Introduction to Delmarva and the QIO Evolution of Quality Improvement and Cost Containment at the Centers for Medicare and Medicaid Services (CMS) 1965 1986 1999-2008 The Quality Improvement Organizations' 9 th Scope of Work 2008-2011 Impetus for Change Goals Process Translating Process to Outcomes Measures Evaluation Transparency: Online Information about Quality and Cost PQRI: Encouraging Physicians to Embrace Transparency
Slide 5Delmarva 'Call to get a level… "
Slide 6Delmarva's Impact Across the United States External Quality Review Medicare Quality Improvement Organization Maryland Patient Safety Center Medicare Quality Improvement Organization External Quality Review (Washington, DC) Statewide Quality Assurance Program for Developmentally Disabled External Quality Review for Medicaid Program Safeguard Contract Western Integrity States Medicare+Choice Quality Assurance/Performance Improvement Project
Slide 7Organizational Structure of Delmarva
Slide 8Quality Improvement Organizations in Maryland and the District of Columbia Delmarva Foundation for Medical Care, Inc . (DFMC) is the CMS-contracted Quality Improvement Organization (QIO) for Maryland Delmarva Foundation of the District of Columbia (DFDC) is the CMS-contracted QIO for DC
Slide 9What is a QIO? The Centers for Medicare and Medicaid Services contracts with one association in each state , the District of Columbia, Puerto Rico, and the Virgin Islands to advance more secure and more viable care in doctor's facilities, doctor works on, nursing homes, home wellbeing offices, wellbeing arrangements, drug stores, and professionally prescribed medication arranges. QIOs give a scope of administrations to the security of the country's 42 million Medicare recipients
Slide 10What Does the QIO Do? The essential objective of the QIO is to quicken the dispersion of proof based medication from the bookshelf to the bedside. As a group asset, the QIO fill in as a national framework that helps specialists, doctor's facilities, home wellbeing organizations and nursing homes use best practices to enhance mind. CMS
Slide 12What Does the QIO Do? Enhances social insurance quality through mediations whose effect on results can be measured Provides specialized support, coaching, instruction and preparing Works with suppliers to help them achieve particular clinical objectives Helps suppliers gather and openly report information on execution measures to provoke change
Slide 13How Has the QIO Improved Quality? Increment utilization of life-sparing medications for MI patients Make surgery more secure by diminishing disease rates Improve nursing home care by guaranteeing restricted utilization of limitations Support home human services to help patients remain out of the doctor's facility
Slide 14Evolution of Quality Improvement and Cost Containment at CMS 1965-1986
Slide 16Evolution of Quality Improvement and Cost Containment at CMS 1965: Medicare enactment Seniors and the crippled 1966: HCFA (now CMS) sets measures for healing facilities that desire to be repaid for Medicare recipients' care
Slide 17Evolution of Quality Improvement and Cost Containment at CMS 1971: EMCROs (Experimental Medical Care Review Organizations) Voluntary doctor bunches Grant subsidized Individual cases for Utilization Review 1972-1982: PSROs (Professional Standards Review Organizations) Medical Necessity Professional Standards Effectiveness and "Financial matters" of Care
Slide 18Evolution of Quality Improvement and Cost Containment at CMS 1982: PROs (Peer Review Organizations) Utilization and Quality Control Beyond nearby standards More government oversight Funding from Medicare Trust Fund 1983: PPS (Prospective Payment System) presented (Maryland is postponed)
Slide 19Evolution of Quality Improvement and Cost Containment at CMS 1984-1986 1 st SOW Era of PRO versus . Suppliers proceeds with PROs are centered around "investigating and distinguishing" and authorizing suppliers 1 st SOW stresses budgetary endorses on doctors for improper confirmations Prospective Payment System (PPS) utilizing DRGs raises worries about early releases and readmissions
Slide 20Evolution of Quality Improvement and Cost Containment at CMS 1986-1999
Slide 21Evolution of Quality Improvement and Cost Containment at CMS 1986-1993 2 nd and 3 rd SOW Medicare Managed Care Organizations Concerns emerge that Medicare MCOs subject suppliers to money related motivators to under utilize administrations 1986 OBRA: PROs to stretch out survey to different settings
Slide 23Evolution of Quality Improvement and Cost Containment at CMS 1986-1990 PRO Problems with Providers Punitive with no positive impetuses Adversarial Redundancy with different projects
Slide 24Evolution of Quality Improvement and Cost Containment at CMS 1990 Institute of Medicine Report on PRO Program Potentially significant framework Improve and expand on PROs New needs Emphasize quality audit and affirmation over UR and cost control More regard for normal practice designs than exceptions Include extra human services settings
Slide 25Evolution of Quality Improvement and Cost Containment at CMS 1990 IOM Recommendations to QIOs Undergo 'self-appraisal' Demonstrate affect on nature of administer to Medicare recipients Include basic supplier input Develop criteria for assessment that is target and very much considered Have access to a Technical Advisory Panel *
Slide 26Evolution of Quality Improvement and Cost Containment at CMS
Slide 27Evolution of Quality Improvement and Cost Containment at CMS Late 1980's-mid 1990s Continuous Quality Improvement: According to the standards of persistent quality change, there is no base adequate level; procedures can simply be moved forward. 1991: The Institute for Healthcare Improvement (IHI) is established.
Slide 28Evolution of Quality Improvement and Cost Containment at CMS 1992 Jencks and Wilensky Recommended a sensational course change from review audit that recognized a couple of poor entertainers to imminent change in nature of tend to all suppliers Health Care Quality Improvement Initiative Focus on practice examples and care results at the institutional and national levels Develop rehearse rules Initiate Cooperative Cardiovascular Project for AMI
Slide 29Evolution of Quality Improvement and Cost Containment at CMS 1993-1996 PRO 4 th SOW PROs Evolve National quality change extends on Heart Failure and Diabetes Emphasis movements to joint effort between governments, suppliers, and buyers Data accumulation strategies enhance
Slide 31Evolution of Quality Improvement and Cost Containment at CMS 1996-1999 PRO 5 th SOW National Health Care Quality Improvement Projects (HCQIP) HCFA-coordinated for statewide effect Local needs appraisals Measurable markers Beneficiary security and objections
Slide 32Evolution of Quality Improvement and Cost Containment at CMS
Slide 33Evolution of Quality Improvement and Cost Containment at CMS Communications
Slide 34Evolution of Quality Improvement and Cost Containment at CMS 1999-2008
Slide 35Evolution of Quality Improvement and Cost Containment at CMS 1999-2002 PRO 6 th SOW National HCQIP Specific sickness subjects AMI, CHF, Pneumonia, Stroke, DM, Breast Cancer Local ventures Expand past intense look after oversaw mind Beneficiary Protection (installment mistake)
Slide 36Evolution of Quality Improvement and Cost Containment at CMS 2002-2005 7 th SOW: "Expert" gets to be "QIO" Specific themes with institutionalized signs for each setting NH, HH, Hospital (AMI, HF, Pneumonia, Surgical diseases), Physician office (DM, Cancer, Immunization) Projects for underserved and country populaces Projects for Medicare oversaw mind Information and Communication Hospital-created execution information QIO Data Warehouse
Slide 37Evolution of Quality Improvement and Cost Containment at CMS 2005-2008 QIO 8 th SOW Developing limit with regards to and accomplishing brilliance Tasks still partitioned by setting of care Physician office extended to incorporate underserved, Part D, and HIT Beneficiary Protection proceeds
Slide 38Quality Improvement and Cost Containment at CMS?
Slide 39Evolution of Quality Improvement and Cost Containment at CMS 2008-2011 QIO 9 th SOW Based on all that went before and then some…
Slide 40Impetus for Change
Slide 41Impetus for Change Improving the Medicare Quality Improvement Organization Program, 2006 Institute of Medicine (IOM) answer to Congress Focus more on quality change and execution estimation Prioritize program assets so that QIO can help suppliers who exhibit the most need, or who confront critical difficulties conveying quality care Strengthen authoritative structure and administration of the QIO Strengthen administration of the QIO program by CMS Strengthen the assessment framework for the QIO program
Slide 42Impetus for Change Nursing Home Report Nursing Homes: Federal Actions Needed to Improve Targeting and Evaluation of Quality Improvement Organizations, 2007 Government Accountability Office (GAO) report Increase the quantity of low-performing nursing homes that QIO helps seriously Direct QIO to concentrate escalated help on those nature of-care ranges in which nursing homes most
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