Medicare Quality Improvement Organizations To Focus On Certain Nursing Homes, Hospitals, CMS Says

CMS last week announced that Medicare quality improvement organizations will focus more of their efforts on nursing homes and hospitals that offer the most likelihood for improvement in selected areas as part of a set of new responsibilities, CQ HealthBeat reports (Reichard, CQ HealthBeat, 2/8).

CMS pays about $300 million annually to contract with 53 QIOs -- organizations based in all 50 states; Washington, D.C.; Puerto Rico; and the Virgin Islands -- to improve the quality of care provided to Medicare beneficiaries (Kaiser Daily Health Policy Report, 8/8/07). In recent months, the Institute of Medicine and the Senate Finance Committee have said that QIOs require management and structural changes.

Under the new responsibilities, QIOs will focus on efforts to reduce the prevalence of bedsores and the use of physical restraints in nursing homes. QIOs also will focus on efforts to prevent postoperative complications, such as infections, in hospitals. Acting CMS Administrator Kerry Weems said that QIOs will focus on about 4,000 nursing homes and 900 hospitals -- not the "worst homes or the worst hospitals," but those most likely to improve in the selected areas.

According to CQ HealthBeat, although CMS is "emphasizing that the facilities aren't the worst performers, the agency is clearly applying public pressure on the target facilities to improve," in part through the publication of the names of the nursing homes and hospitals on the agency Web site. The move will help consumers make "informed choices about health care," CMS said in a statement (CQ HealthBeat, 2/8).


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