Winds of Change for Quality Improvement Organizations (QIOs) Part 2

on Monday, 21 July 2014. All News Items | Case Management | Quality | Coding

In early May of this year CMS posted a Press Release announcing the “agency’s first step in restructuring the Quality Improvement Organization (QIO) Program to improve patient care, health outcomes, and save taxpayer resources.” On Friday July 18th they released a second Press Release launching the next phase of the QIO restructuring. Before we delve into the most recent Press Release, here is a quick recap of the May announcement.

Highlights from May 9th Press Release:

With the 11th Scope of Work (SOW) set to begin August 1st, 2014 the CMS will be implementing the following changes:

  • Separation of case review from quality improvement,
  • Extending the contract period of performance from three (3) to five (5) years,
  • Removing requirements to restrict QIO activity to a single entity in each state/territory, and
  • Opening contractor consideration to a broad range of entities to perform the work.

Phase One: Beneficiary and Family Centered Care (BFCC) QIOs

There will be two BFCC QIOs that “will be responsible for ensuring the consistency in the review process with consideration of local factors important to beneficiaries.”

Type of Case Reviews to be performed by the BFCC QIOs includes:

  • Complaint Reviews
  • Quality of Care Reviews
  • Discharge Appeals
  • Higher Weighted Diagnostic Related Groups (DRG) requests
  • Emergency Medical Treatment and Active Labor Act (EMTALA) reviews.

BFCC QIO Coverage Areas:

CMS has awarded the two BFCC QIO contracts to Livanta, LLC located in Annapolis Junction, Maryland and KePRO located in Seven Hills Ohio. The 50 states, DC, Puerto Rico and the Virgin Islands have been divided into Five (5) Areas. In a July 23rd National Provider Call a map of the coverage areas was provided in the slide deck.

BFCC QIO Coverage Areas

Map of BFCC QIO Coverage Areas

Area

Address

Toll-Free Number

Fax Number

Livanta
1 Livanta BFCC-QIO Program
9090 Junction Drive, Suite 10
Annapolis Junction, MD 20701
866-815-5440 Appeals: 855-236-2423
All other reviews 844-420-6671
5 Livanta BFCC-QIO Program
9090 Junction Drive, Suite 10
Annapolis Junction, MD 20701
877-588-1123 Appeals: 855-694-2929
All other reviews 844-420-6672
KEPRO
2 5201 W. Kennedy Blvd.,
Suite 900
Tampa, FL 33609
844-455-8708 844-834-7129
3 5700 Lombardo Center Dr.,
Suite 100
even Hills, OH 44131
844-430-9504 844-878-7921
4 5201 W. Kennedy Blvd.,
Suite 900
Tampa, FL 33609
855-408-8557 844-834-7130

 

Phase Two: Quality Innovation Network (QIN) QIOs

Per the July 18th Press Release, CMS has awarded new contracts to fourteen organizations who will “work with providers and communities across the country on data-driven quality initiatives. These QIOs will be known as the Quality Innovation Network (QIN)-QIOs.” Specific examples of strategic initiatives that the QIN-QIOs will work on include:

  • Reducing healthcare associated infections,
  • Reducing readmissions and medication errors,
  • Working with nursing homes to improve care for residents,
  • Supporting clinical practices in using interoperable health information technology to enable the exchange of essential health information to improve the coordination of care, promoting prevention activities, reducing cardiac disease and diabetes, reducing health care disparities and improving patient and family engagement;” and
  • Provide technical assistance for improvement in CMS value based purchasing programs, including the physician value based modifier program.”

Below is a table of contract awardees that CMS provided in the Press Release.

11th Statement of Work Quality Innovation Network Quality Improvement Organization Program Contracts

Quality Innovation Network (QIO)States in QIO
Great Plains Quality Innovation Network KS, ND, NE, SD
TMF AR, MO, OK, TX
Lake Superior Quality Innovation Network/Stratis Health MN, WI, MI
Telligen CO, IA, IL
HealthInsight NM, NV, OR, UT
Alliant-Georgia Medical Foundation GA, NC
atom Alliance AL, KY, MS, TN
Mountain Pacific Quality Health Foundation AK, HI, MT, WY
Atlantic Quality Improvement Network DC, NY, SC
Quality Insights Quality Innovation Network DE, LA, NJ, PA, WV
VHQC MD, VA
Qualis Health ID, WA
Health Services Advisory Group AZ, CA, FL, OH
HealthCentric Advisors CT, MA, ME, NH, RI, VT
The Indiana, Puerto Rico, and Virgin Islands awards have not yet been determined.

What you need to know by August 1st:

  • You will need to identify who your BFCC QIO is in order to know:

QIO Resources

Link to slides from July 23rd National Provider call on the QIO Program Transition: http://www.qioprogram.org/sites/default/files/ProviderCallSlides%2007232014.pdf

Link to July 18th Press Release: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2014-Press-releases-items/2014-07-18.html

Link to May 9th Press Release: http://cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2014-Press-releases-items/2014-05-09.html?DLPage=1&DLSort=0&DLSortDir=descending

Link to CMS QIO webpage: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityImprovementOrgs/index.html?redirect=/qualityimprovementorgs/

Article by Beth Cobb

Beth Cobb, RN, BSN, ACM, CCDS, is the Manager of Clinical Services at Medical Management Plus, Inc. Beth has over twenty-three years of experience in healthcare including eleven years in Case Management at a large multi-facility health system. In her current position, Beth monitors, interprets and communicates current and upcoming Case Management / Clinical Documentation issues as they relate to specific entities concerning Medicare. You may contact Beth at This email address is being protected from spambots. You need JavaScript enabled to view it..

This material was compiled to share information. MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.

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