Quality Improvement Organizations Begin Restructuring the QIO Program
August 1, 2014 10:56 AM
Quality Improvement Organizations (QIO) have begun activities related to the restructuring the QIO Program that aims to improve patient care and health outcomes, and to better coordinate QIO resources.
This first phase of the restructuring allows two Beneficiary and Family-Centered Care (BFCC) QIO contractors to support the program’s case review and monitoring activities separate from the traditional quality improvement activities of the QIOs. The two BFCC QIO contractors are Livanta LLC, located in Annapolis Junction, Maryland, and KePRO, located in Seven Hills Ohio.
The BFCC QIOs will provide services across the five geographic areas listed below.
.Area 1: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Puerto Rico, Rhode Island, Vermont, Virgin Islands
Area 2: District of Columbia, Delaware, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia
Area 3: Alabama, Arkansas, Colorado, Kentucky, Louisiana, Mississippi, Montana, North Dakota, New Mexico, Oklahoma, South Dakota, Tennessee, Texas, Utah, Wyoming
Area 4: Iowa, Illinois, Indiana, Kansas, Michigan, Minnesota, Missouri, Nebraska, Ohio, Wisconsin
Area 5: Alaska, Arizona, California, Hawaii, Idaho, Nevada, Oregon, Washington
The geographic Area 1 and Area 5 were awarded to Livanta, LLC.
The contract awards for Areas 2, 3 and 4 were awarded to KePRO
Beneficiary appeals related to Notices of Medicare Non-Coverage (NOMNC) that home health and hospice agencies issue upon discharge is one function the BFCCs will be preforming. Home health and hospice agencies will need to revise the NOMNC to reflect the name and contact information of the new QIO.
Agencies have raised concerns about how to handle large numbers of forms that have already been preprinted with the previous QIOs name and contact information. CMS recently provided the following guidance regarding methods that are permissible in revising existing forms.
“We expect Medicare providers/contractors to ensure affected Medicare notices reflect the correct, updated QIO contact information as quickly as possible as and no later than September 1, 2014.
CMS is not prescribing how Medicare providers/contractors update Medicare notices with the new QIO contact information (e.g., whether the new QIO contact information is written-in or printed on a sticker or label). The goal is to provide the updated information as quickly and accurately as possible and to ensure that beneficiaries know who to call. Again, whichever method is selected, we ask providers/contractors to please ensure the updated QIO contact information it is clearly identified.”
Agencies should download templates of the NOMNC here and update them accordingly as soon as possible.
The National Association for Home Care & Hospice has developed a chart with the name and contact information for the two BFCC QIOs according to geographic area.
In order to ensure a smooth transition, incumbent QIOs have begun messaging about the change and telephone numbers will be rolled over to the new BFCC QIOs, and/or the incumbent QIOs will revise their automated directories to reflect the new contact information.
In addition to the BFCC QIOs, CMS has contracted with 14 fourteen organizations that will work with providers and communities across the country on data-driven quality initiatives. These QIOs will be known as Quality Innovation Network (QIN)-QIOs.
QIN-QIO projects will be based in communities, health care facilities and clinical practices. They will drive quality by providing technical assistance, convening learning and action networks for sharing best practices, collecting and analyzing data for improvement.
The QIN-QIOs will work on strategic initiatives outlined in the 11the Statement of Work, such as, but not limited to, reducing healthcare associated infections, reducing readmissions and medication errors. QIN-QIOs will also provide technical assistance for improvement in CMS value based purchasing programs, including the physician value based modifier program. As a result of the changes, some home health and hospice providers will now work with a different QIO than in the past
Home health and Hospice providers are encouraged to work with the new QIO contractors in order to promote new approaches to improve care for beneficiaries, families and caregivers.