Feds Restructure Medicare QIO Activities

CMS has restructured the QIO Program from its previous 53 contracts, in which each QIO performed both case review and quality improvement support for each state or territory. Now, there is a regional structure for case review and an industry-determined service structure for quality improvement initiatives. In the new structure, case review and quality improvement functions are performed by different contractors; the contract periods are extended from 3 to 5 years; and there is enhanced focus on learning, collaboration, and the dissemination of best practices. Now, one group of QIOs will handle complaints while another group will provide technical assistance to support providers and suppliers. The Beneficiary and Family Centered Care Quality Improvement Organizations (BFCC-QIOs) manage all beneficiary complaints and quality of care reviews to ensure consistency in the review process while taking into consideration local factors important to beneficiaries and their families. Quality Innovation Network (QIN) QIOs will be responsible for working with providers and the community on multiple, data-driven quality initiatives to improve patient safety, reduce harm, and improve clinical care at their local and regional levels. On August 1, 2014, all current and future beneficiary quality review casework and appeals in New York will be conducted by Livanta LLC of Annapolis Junction, MD. CMS will shortly award the regional QIN-QIO contracts. A list of the current BFCC-QIOs and QIN-QIOs for each area, and their contact information, are located at QIOProgram.org. More information on the QIO Program can be found at QIOProgram.org or by contacting 1-800-MEDICARE.