CMA urges CMS to postpone changes to QIO program July 25, 2013 Medicare Centers for Medicare and Medicaid Services, Insurance/Reimbursement, Quality of Care, Medicare 0 The Centers for Medicare and Medicaid Services (CMS) recently called for public comments on how it can best organize the national cadre of Medicare Quality Improvement Organization (QIO) contractors. The mission of the QIO program is to improve the effectiveness, efficiency, economy and quality of services delivered to Medicare beneficiaries. Currently, CMS contracts with one organization in each state to serve as that state's QIO contractor. QIOs are private, mostly not-for-profit organizations, staffed by physicians and other health care professionals who are trained to review medical care, help beneficiaries with complaints about the quality of care they receive, and to implement quality improvements throughout the spectrum of care. CMS is looking for provider opinions about four potential options that it may use to divide work among a varying number of QIO contractors into service areas (jurisdictions or regions) that are focused on quality-improvement-related work only. CMS is also seeking fresh new ideas about other options for organizing QIO contractors. The California Medical Association (CMA) joined the American Medical Association (AMA) and other medical organizations to urge CMS to postpone any changes to the QIO contracting process until a later date, as there is no statutory mandate requiring them to make changes. With the health care industry facing the imminent implementation of the Affordable Care Act, as well as the value-based payment modifier, ICD-10 and meaningful use, CMA doesn't believe it is wise to undertake yet another large scale change at this time. "All of these legislative mandates require learning curves that involve changes to practice infrastructure, staffing, workflow and other costly burdens," wrote the groups in a letter to CMS. The letter urged CMS to postpone consideration of QIO changes until the pace of health care reform is less frenetic, physician practices are more stable and we all have a clearer sense of how the QIO changes would impact quality and cost. "Moreover, one measurable impact of the health care exchanges will be the influx of millions of new patients into the health care system. Physicians are likely to lean on their QIOs for help to ensure that these new patients, many of whom will have newly diagnosed and/or untreated conditions, receive high quality and cost effective care," the letter said. "It is unwise to pursue a consolidation of the local QIOs, which are community resources that are trusted by patients and providers alike, just as the demand for services is likely to increase." View the letter here. Contact: Elizabeth McNeil, (800) 786-4262 or ecmneil@cmanet.org. Comments are closed.
