QIOs: Partners for Rural Health Care Quality Improvement

1
QIOs Partners for Rural Health Care Quality
Improvement

• David G. Schulke
• Executive Vice President
• The American Health Quality Association
• Office of Rural Health Policy
• All Programs Meeting
• Washington, D.C.

2
A National Network of Health CareQuality
Improvement Organizations

• AHQA members 40 private organizations dedicated
  to community-based quality improvement.
• Renamed QIOs in 2002, same as the 53 Medicare
  Peer Review Organizations (PROs).
• QIO program created by Congress in 1982.
• 1984-92 primarily case review to control PPS
  utilization, spotlight poor quality.
• 1993-present facilitating voluntary clinical
  quality improvement collaborations.
• Statutory QIO confidentiality rules prohibit
  release of information identifying patient,
  practitioner, reviewer.

3
Statutory Scope of QIO Work(Source Title 11,
Social Security Act)

• Improve the quality of care for Medicare
  beneficiaries, promoting evidence-based medicine.
• Protect the integrity of the Medicare Trust Fund
  by ensuring that Medicare pays only for
  reasonable and necessary items and services in
  the most economical setting.
• Protect beneficiaries by investigating EMTALA and
  other complaints, hospital discharge appeals.

4
QIOs Support Quality Improvement in Facilities
with Limited Resources

• QIOs provide free of charge
• Educational materials (e.g.,guidelines, summaries
  of best practices).
• Examples of interventions (e.g., standing orders,
  clinical pathway, discharge protocols/checklists).
  
• Customized user-friendly data collection tools
  (paper or electronic) and support for self
  collection and analysis).

5
Care Settings for QIO Work in All States,
2002-2005

• Hospitals AMI, CHF, Pneumonia treatment and
  prevention, Surgical infection prevention
• Physician Offices Promote mammography, diabetes
  care, flu and pneumonia prevention.
• Nursing Homes Focus on three quality topics
  (mostly pain and pressure ulcers) and assist
  public in understanding 10 publicly reported
  Quality Measures (based on MDS data).
• Home Health Agencies Teach improvement and
  assist public with 11 publicly reported Quality
  Measures (based on OASIS data).

6
National Reports Recommend More QIO Work in Rural
Areas

• National Advisory Committee on Rural Health (2001
  and 2003) reports MedPAC (2001)
• Discussed the successful quality improvement work
  of the QIOs and the continued unmet needs of
  rural providers.
• Recommended CMS develop quality indicators and
  data collection tools suitable for low-volume
  rural providers and require the QIOs to work in
  rural areas.

7
QIO Medicare Contract Some Encouragement for
Rural Work

• Each QIO evaluated for statewide improvement on
  population based quality indicators.
• Trade-offs
• Policy works to encourage QIOs to help the
  largest number of beneficiaries
• Policy encourages QIOs to work with high volume
  providers in large population centers.
• Rural focused projects are not required -- rural
  projects are an option under the same contract
  category as disparities projects to reduce the
  quality gap affecting vulnerable racial and
  ethnic populations.

8
Current QIO Rural Health Care Quality Improvement
Projects

• Several QIOs include rural providers in some or
  all national projects (e.g., AR, MN)
• 19 QIOs chose rural populations for disparity
  work
• Pneumonia IA, ID, MT, NE, PR, WV (ABX timing
  Immunization)
• Heart Failure IL, ME, NH, ND, VT (LVEF)
• Diabetes AR, GA (HbA1c)
• Surgical Site Infection AK (ABX timing)
• Three projects in Native American populations
  NV, UT (Immunization), SD (Diabeteslipid test)

9
Example of QIO Work with Small Hospitals
Oklahoma Pneumonia Project

• Controlled study in 36 hospitals
• Intervention hospitals (20) -- median licensed
  beds 40, average daily census 10, 4 JCAHO
  accredited
• Control hospitals (16) -- median licensed beds
  40, average daily census 8, 4 JCAHO
• Measures of performance
• Sputum and blood cultures, antibiotics given in 4
  hours, antibiotics given in the E.D.

10
Example of QIO Work with Small Hospitals
Oklahoma Pneumonia Project
11
Example of QIO Work with Small Hospitals
Oklahoma Pneumonia Project
Compares performance on quality indicators from
Baseline 2 to Follow-up.
12
Proposal for New Rural and Low-Volume Provider
Section of QIO Contracts

• AHQA is developing a proposal to create a new
  section in QIO contracts in the Eighth Scope of
  Work (2005-08). The current draft says
• QIOs in states with between 20-60 of their
  Medicare beneficiaries living in non-metro
  counties would be required to work with
  low-volume providers in rural counties.
• Less than 20 rural population could work with
  low-volume providers anywhere in the state.
• More than 60 rural presumably already working
  with rural providers to effect statewide
  improvement.
• Must coordinate with State Offices of Rural
  Health where possible.

13
Questions and Comments

• David G. Schulke
• Executive Vice President
• Sylvia Whitlock
• Director, Government Affairs
• American Health Quality Association
• Washington, D.C.
• DSchulke_at_ahqa.org
• SWhitlock_at_ahqa.org