Tough love

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The Centers for Medicare & Medicaid Services is getting tough with its Medicare contractors, Quality Improvement Organizations.

This week, CMS released its 9th Statement of Work. The three-year contract, which begins in August, attempts to “improve oversight of QIOs” to ensure they improve the quality of care among healthcare providers, including nursing homes.

CMS will link QIOs’ work to measurable outcomes during the length of the three-year contract, the agency said. It also is focusing on accountability in this new contract. It has publicly identified nursing homes and hospitals with the greatest need to reduce pressure ulcer and restraint use.

“By posting information about these facilities, CMS strengthens its commitment to increasing the transparency of information available to consumers in the healthcare market,” CMS said.

In yet another move towards transparency, CMS is requiring that eight troubled QIOs compete for contract awards for the 9th Statement of Work. Those eight come from states that did not meet the performance criteria outlined earlier.

CMS admits that the crackdown is in response to embarrassing findings by the Institute of Medicine and the Government Accountability Office. In recent years these agencies have released reports calling for CMS to clean up the organizational structure and governance of QIOs and direct QIOs to focus on improving quality at low-performing facilities.

The QIO program was created in 1982 to improve the quality, safety and efficiency of healthcare services delivered to Medicare beneficiaries. In recent years it appears they have failed to live up to expectations.

This new initiative offers some constructive ways for QIOs to restore the government’s trust. Whether they are up to the task remains to be seen.

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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.