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QUALITY IMPROVEMENT ORGANIZATIONS (QIOs)

Improving Patient Care Across the Continuum of Care

Care Transitions May Improve Patient Safety and Quality of Care

The majority of VTEs in THR and TKR surgeries occur after hospital discharge, yet the number of patients receiving VTE prophylaxis declines after patients leave the hospital.11

  • The Care Transitions Project is a CMS-sponsored pilot program that seeks to improve health care processes and reduce hospital readmissions by promoting seamless transitions from the hospital to home, skilled nursing facilities (SNFs), or home health care40
  • Ramifications of miscommunication between care providers include41
    • Patient or caregiver confusion about the patient's condition and appropriate care
    • Lack of follow-through on referrals and inconsistent patient monitoring
    • Medication errors, overuse of narcotics, and suboptimal use of medicines
    • Increased financial impact and duplication of resource utilization
  • Medicare patient movement from acute care to other care settings such as SNFs has led to patient dissatisfaction and fragmented care42

Acute Care Episode (ACE)—the Right Care for Every Person Every Time43

  • The ACE Demonstration 3-year pilot program will test the effects of bundling Medicare Part A and Part B payments by episodes of care as an alternative approach to payment for health care service delivery. The global payment will cover all Part A and Part B services, including physician services, as they pertain to the inpatient stay for fee-for-service beneficiaries43
  • The episodes of care will be for various cardiovascular and orthopedic procedures, and participating sites will be called value-based care centers43,44
  • Incentives will be offered to Medicare providers who demonstrate measurable clinical quality and efficiency improvements to Medicare beneficiaries43
  • A measure for VTE prophylaxis following surgery for THR and TKR surgery patients is included45

Quality Improvement Organizations

  • Quality improvement organizations (QIOs) enhance seamless care transitions40
  • QIOs are contracted with CMS to safeguard the care of Medicare beneficiaries and are assigned in all 50 states46
  • QIOs partner with physicians, hospitals, SNFs, and beneficiaries to measure the delivery of high-quality care across the health care continuum46
  • QIOs measure how often health care quality is delivered according to clinical indicators. When care is not up to standard, QIOs collaborate with health care providers to improve processes and make suggestions46
  • QIO interventions have been proven successful. In 2002, QIOs trained staff from more than 50 hospitals nationally in an effort that resulted in a 27% overall improvement in reducing surgical site infections47
  • Continuity of care is a major theme of the CMS QIO 9th Statement of Work48
    • Implement quality initiatives throughout designated local health care systems to identify systemwide weaknesses and provide effective solutions
    • Develop an Internet-based Continuity Assessment Record and Evaluation (CARE) instrument
      • —  Standardized tool that will enable a variety of health care providers to uniformly measure and compare Medicare beneficiaries' health and functional status over time and across care settings (hospitals, SNFs, inpatient rehabilitation centers, etc)