The QIO Program,Home Health,and the National Acute Care Hospitalization Priority

Abstract

The Centers for Medicare & Medicaid Services (CMS), previously the Health Care Financing Administration (HCFA), an agency of the U.S. Department of Health and Human Services, has been committed to improving the quality of care to Medicare beneficiaries since the inception of the Medicare Program. This commitment is evident in the Quality Improvement Organization (QIO) Program. In 2003, the QIOs worked to promote public reporting and the Home Health Compare Web site and improving the performance on publicly reported quality measures. Beginning in 2005, the QIO work in home health expanded to include adult immunizations, telehealth, and organizational culture. Currently, the QIOs primarily focuses efforts on the home health national-priority topic of reducing avoidable hospitalizations as measured by the publicly reported measure of acute care hospitalization or ACH. The focus on reducing avoidable hospitalizations became heightened with the yearlong Home Health Quality Improvement National Campaign, which began in January 2007.

Keywords

acute care hospitalization CMS QIO quality quality measures Quality Improvement Organization scope of work SOW

Get full access to this article

View all access options for this article.

References

Bhatia, A. , Blackstock, S. , Nelson, R. , & Ng, T.S. (2000). Evolution of quality review programs for Medicare: Quality assurance to quality improvement. Health Care Financing Review, 22(1), 69-74.

Essey, M. , & Hunt, S. (2006, October). Medicare QIO home health agency collaboration: The present and future of quality improvement. Paper presented at the annual meeting of the National Association for Home Care and Hospice, Baltimore, MD.

Grant, J.B. , Hayes, P.E. , Risa, P. , Pates, R.D. , & Elward, K.S. ( 1996). HCFA's Health Care Quality Improvement Program: The medical informatics challenge. Journal of the American Medical Informatics Association, 3(1), 15-26.

Institute of Medicine. (1990). Medicare: A strategy for quality assurance (Vol. 1). Washington, DC: National Academy Press.

Institute of Medicine. (1994). An assessment of the HCFA evaluation plan for the Medicare peer review organization . Washington, DC: National Academy Press.

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.

Institute of Medicine. (2006). Pathways to quality health care Medicare's Quality Improvement Organization Program maximizing potential. Washington, DC: National Academy Press.

Rollow, W. , Lied, T.R. , McGann, P. , Poyer, J. , LaVole, L. , Kambic, R. , et al. (2006). Assessment of the Medicare Quality Improvement Organization Program. Annals of Internal Medicine, 145, 342-353.

U.S. Department of Health and Human Services. ( 2007a). Home health compare. Retrieved February 28, 2007, from https://www.medicare.gov.

10.

U.S. Department of Health and Human Services. ( 2007b). Nursing home compare. Retrieved February 28, 2007, from https://www.medicare.gov.

11.

U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. (2002a). OBQI satellite broadcast. Retrieved March 14, 2007, from https://www.qtso.com/hhanews2002.html.

12.

U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. (2002b, October). Outcome based quality improvement implementation manual. Retrieved March 14, 2007, from http://www.cms.hhs.gov/HomeHealthQualityInits/16_HHQIOASISOBQI.asp#TopOfPage .

13.

U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. (2002c). Statement of work, QIOs: 7th Round, February 2002 Version. Washington DC: Government Printing Office.

14.

U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. (2006a). CMS quality improvement roadmap. Retrieved March 15, 2007, from http://www.cms.hhs.gov/CouncilonTechInnov/downloads/qualityroadmap.pdf .

15.

U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. (2006b). Medicare quality improvement organization priorities. Retrieved March 15, 2007, from http://www.mrnc.org/mrnc_web/documents/CORP/_Default/8SOW_MedicarePriorities_21306_FINAL.pdf .

16.

U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. (2007a). Home health quality initiatives overview. Retrieved March 1, 2007, from http://www.cms.hhs.gov/HomeHealthQualityInits/.

17.

U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (2007b). Nursing home quality initiatives. Retrieved March 1, 2007, from http://www.cms.hhs.gov/NursingHomeQualityInits/.