Quality improvement organizations
Encyclopedia
Quality Improvement Organizations (QIOs) monitor the appropriateness, effectiveness, and quality of care provided to Medicare
beneficiaries. They are private contractor extensions of the federal government
that work under the auspices of the U.S. Centers for Medicare and Medicaid Services
(CMS).
In recent years QIOs have undertaken to facilitate continual improvement of health care services within their constituent communities in addition to their original and ongoing statutory audit/inspection role of medical peer review
, i.e., akin to the traditional function of quality assurance
. This shift in emphasis began in the mid-1990s and has accelerated into the 21st century. Originally known as PROs (Peer Review Organizations), their name was officially changed to QIOs as per the Federal Register on May 24, 2002 in large part to reflect this new emphasis on population-based quality improvement. CMS contracts with QIOs in three year cycles, referred to as "Statements of Work" (SOWs). QIOs are staggered into three categories (round 1, round 2, and round 3) - each of these three groups start their contract cycle at slightly different times (usually offset by several months). QIOs are currently in their Tenth SOW, which started in August, 2011 (for round 1 QIOs). The 9SOW continued the theme of "transformational change" to be achieved through accelerating the rate of quality improvement, raising the bar for performance, and facilitating profound cultural change by incorporating Health Information Technologies.
An example of current QIO quality improvement work is that of the federal Doctor's Office Quality Information Technology initiative (DOQ-IT) , which:
Another example is:
QIOs also help coordinate and facilitate the timely submission of data for public reporting of institution-specific quality measure performance information that is available on CMS websites such as "Nursing Home Compare" and "Hospital Compare".
In recent years, QIO hospital work has tended to reinforce and complement that of the Institute for Healthcare Improvement (based in Cambridge, MA).
The QIOs are represented nationally by the American Health Quality Association.
Medicare (United States)
Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other...
beneficiaries. They are private contractor extensions of the federal government
Federal government of the United States
The federal government of the United States is the national government of the constitutional republic of fifty states that is the United States of America. The federal government comprises three distinct branches of government: a legislative, an executive and a judiciary. These branches and...
that work under the auspices of the U.S. Centers for Medicare and Medicaid Services
Centers for Medicare and Medicaid Services
The Centers for Medicare & Medicaid Services , previously known as the Health Care Financing Administration , is a federal agency within the United States Department of Health and Human Services that administers the Medicare program and works in partnership with state governments to administer...
(CMS).
In recent years QIOs have undertaken to facilitate continual improvement of health care services within their constituent communities in addition to their original and ongoing statutory audit/inspection role of medical peer review
Medical peer review
Medical peer review is the process by which a committee of physicians examines the work of a peer and determines whether the physician under review has met accepted standards of care in rendering medical services. Depending on the specific institution, a medical peer review may be initiated at the...
, i.e., akin to the traditional function of quality assurance
Quality Assurance
Quality assurance, or QA for short, is the systematic monitoring and evaluation of the various aspects of a project, service or facility to maximize the probability that minimum standards of quality are being attained by the production process...
. This shift in emphasis began in the mid-1990s and has accelerated into the 21st century. Originally known as PROs (Peer Review Organizations), their name was officially changed to QIOs as per the Federal Register on May 24, 2002 in large part to reflect this new emphasis on population-based quality improvement. CMS contracts with QIOs in three year cycles, referred to as "Statements of Work" (SOWs). QIOs are staggered into three categories (round 1, round 2, and round 3) - each of these three groups start their contract cycle at slightly different times (usually offset by several months). QIOs are currently in their Tenth SOW, which started in August, 2011 (for round 1 QIOs). The 9SOW continued the theme of "transformational change" to be achieved through accelerating the rate of quality improvement, raising the bar for performance, and facilitating profound cultural change by incorporating Health Information Technologies.
An example of current QIO quality improvement work is that of the federal Doctor's Office Quality Information Technology initiative (DOQ-IT) , which:
- promotes the adoption of electronic health recordElectronic Health RecordAn electronic health record is an evolving concept defined as a systematic collection of electronic health information about individual patients or populations...
systems and information technologyInformation technologyInformation technology is the acquisition, processing, storage and dissemination of vocal, pictorial, textual and numerical information by a microelectronics-based combination of computing and telecommunications...
in small-to-medium sized physician offices with a vision of enhancing access to patient information, decision support, and reference data, as well as improving patient-clinician communications.
Another example is:
- national coordination and support of the Surgical Care Improvement Project (SCIP)http://www.medqic.org/scip/, a hospital based quality improvement initiative led by CMS that focuses on reducing the rate of adverse outcomes of common surgical procedures. This is an effort endorsed by the Centers for Disease Control (CDC), the American College of Surgeons (ACS), the American Hospital Association (AHA), and a large number of professional societies that include physicians, pharmacists, nurses, anesthesiologists, and others. It is estimated that adoption of all the "bundles" of suggested care in the areas of surgical site infection, cardiovascular care, venous thromboembolism prevention, and pulmonary care, could reduce the rate of surgical morbidity and mortality by 25% by the year 2010.
QIOs also help coordinate and facilitate the timely submission of data for public reporting of institution-specific quality measure performance information that is available on CMS websites such as "Nursing Home Compare" and "Hospital Compare".
In recent years, QIO hospital work has tended to reinforce and complement that of the Institute for Healthcare Improvement (based in Cambridge, MA).
The QIOs are represented nationally by the American Health Quality Association.
QIO Listings
There are 53 QIO contracts. The companies holding these contracts are listed below by state/territory:- Alabama - AQAF
- Alaska - Mountain-Pacific Quality Health Foundation
- Arizona - Health Services Advisory Group
- Arkansas - Arkansas Foundation for Medical Care
- California - Health Services Advisory Group
- Colorado - Colorado Foundation for Medical Care
- Connecticut - Qualidigm http://www.qualidigm.org
- Delaware - Quality Insights of Delaware
- District of Columbia - Delmarva Foundation for Medical Care
- Florida - FMQAI http://www.fmqai.com
- Georgia - Georgia Medical Care Foundation http://www.gmcf.org
- Hawaii - Mountain-Pacific Quality Health Foundation
- Idaho - Qualis Health
- Illinois - Illinois Foundation for Quality Health Care
- Indiana - Health Care Excel
- Iowa - Iowa Foundation for Medical CareIowa Foundation for Medical CareIowa Foundation for Medical Care is a non-profit organization which provides services in health care quality improvement and medical information management. IFMC is based in West Des Moines, Iowa and has offices in Illinois, Maryland and Oklahoma. Annual revenues are approximately US $100 million...
- Kansas - Kansas Foundation for Medical Care, Inc.
- Kentucky - Health Care Excel
- Louisiana - Louisiana Health Care Review
- Maine - Northeast Health Care Quality Foundation
- Maryland - Delmarva Foundation for Medical Care
- Massachusetts - MassPRO
- Michigan - MPROMproPRO is an umbrella term that covers a whole range of potential types of measurement but is used specifically to refer to questionnaires completed by the patient. PRO data may be collected via self-administered questionnaires completed by the patient or via interviewer-administered questionnaires...
- Minnesota - Stratis Health
- Mississippi - Information & Quality HealthcareInformation & Quality HealthcareFounded in 1971, Information & Quality Healthcare , also known as the Mississippi Foundation For Medical Care , is a nonprofit, voluntary-membership association that shares information and promotes quality improvement. Nearly 2000 Mississippi physicians make up the voluntary membership...
- Missouri - PrimarisPrimarisThis article refers to the health care company Primaris. See also Primaris Airlines.Primaris is a nonprofit health care consulting company in Columbia, Missouri...
http://www.primaris.org
- Montana - Mountain-Pacific Quality Health Foundation
- Nebraska - CIMRO of Nebraska
- Nevada - HealthInsight
- New Hampshire - Northeast Health Care Quality Foundation
- New Jersey - Healthcare Quality Strategies, Inc.
- New Mexico - New Mexico Medical Review Association
- New York - IPROIPROIsland Peer Review Organization is one of the federally designated Quality improvement organizations in the United States. Headquartered in Lake Success, New York, IPRO has offices in New York City and Albany, New York....
- North Carolina - The Carolinas Center for Medical Excellence
- North Dakota - North Dakota Health Care Review
- Ohio - Ohio KePRO
- Oklahoma - Oklahoma Foundation for Medical Quality
- Oregon - Acumentra Health
- Pennsylvania - Quality Insights of Pennsylvania
- Puerto Rico - Quality Improvement Professional Research Organization, Inc.
- Rhode Island - Quality Partners of Rhode Island
- South Carolina - The Carolinas Center for Medical Excellence
- South Dakota - South Dakota Foundation for Medical Care
- Tennessee - QSource
- Texas - TMF Health Quality Institute
- Utah - HealthInsight http://www.healthinsight.org/
- Vermont - Northeast Health Care Quality Foundation
- Virgin Islands - Virgin Islands Medical Institute
- Virginia - Virginia Health Quality CenterVirginia Health Quality CenterVirginia Health Quality Center was an independent, not-for-profit corporation that primarily focused on health care quality assessment services. Their role was to assess the needs, implement improvements, and evaluate results as it related to how medical care is delivered by health care providers...
- Washington - Qualis Health
- West Virginia - WVMI Quality Insights
- Wisconsin - MetaStar
- Wyoming - Mountain-Pacific Quality Health Foundation
External links
- QIOs, from the CMS website
- American Health Quality Association
- Medicare Quality Improvement Community Online resources to support quality improvement in Medicare.
- Institute for Healthcare Improvement Not for profit group that promotes national and worldwide quality improvement and sponsors conferences, education and training, and publications in this area.
- Mississippi QIO