Patricia Simino Boyce
Study by IPRO Looks at Value of Quality Improvement Organization Program
LAKE SUCCESS, N.Y. – July 10, 2007 — In a new study, researchers found that Quality Improvement Organization (QIO) program efforts in the nation’s nursing homes were “a very sound investment” for Medicare. Under contract with the Centers for Medicare & Medicaid Services (CMS), QIOs work collaboratively with health care providers to improve the quality of care provided to Medicare beneficiaries. The study is one of the first to show the value of the QIO program, as opposed to its effectiveness.
Researchers from IPRO (New York’s QIO) and University of Albany found that the cost of the program was far less than that typically spent on other health care quality interventions. Using a cost-effectiveness measure called a “quality-adjusted life year (QALY),” they estimated a cost of between $2,063 and $7,667 for each QALY gained from nursing home quality improvement efforts. In the U.S., a QALY falling between $50,000 and $100,000 is commonly considered a good value. In addition, they found that up to 46,966 fewer long-term nursing home residents experienced moderate or severe pain, as many as 20,288 fewer short-term residents experienced pain at these levels, and 26,832 fewer residents were put in physical restraints due to quality improvements achieved during the study period.
A QALY is a measure of the outcome of individual actions or programs in terms of their health impact. If an action gives a person an extra year of healthy life expectancy, that counts as one QALY. If an action gives a person an extra year of life expectancy in less than perfect health (e.g., partly disabled or in some distress), it has a value of less than one. The QALY is commonly used to evaluate the cost-effectiveness of treatments or other interventions to improve health. For example, studies have estimated that the cost of each QALY produced by mammography screening for breast cancer and colonoscopy screening for colon cancer is between $10,000 and $25,000; a QALY gained for a person with heart disease treated with cholesterol medications costs $10,000 – $50,000; and the cost of a QALY for a patient with end-stage renal disease receiving dialysis is between $50,000 and $100,000.
“Even with conservative assumptions about QIO program impact, CMS’ investment in nursing home QIO activities appears to be a good value for health care dollars,” said study author Anthony Shih, MD, MPH. Now Senior Program Officer for Quality Improvement & Efficiency with the Commonwealth Fund, Shih worked on the study while serving as Vice President, Quality Improvement with IPRO. The study is published in the spring 2007 issue of Health Care Financing Review, a CMS journal, and is now available on the Web:http://company.ipro.org/index/cms-nh20070710
Shih and colleagues Thomas Hartman, Vice President for Health Care Quality Improvement, IPRO, and Diane M. Dewar, PhD, Associate Professor, University of Albany analyzed the cost of QIO intervention as compared with its quality-of-life benefit for Medicare beneficiaries, across the most common measures of quality of nursing home care. Gains in health care quality that could be attributable to the QIO work were translated into QALYS. Dollar values were placed on improvement in the areas of pain (short and long-term patients) and physical restraints. These measures, along with measures addressing loss of function and pressure sores, are the most frequent areas in which QIOs across the nation have worked with nursing homes. The researchers looked at nursing home quality at the beginning of the national Nursing Home Quality Initiative, and again in 2004, when nursing home quality was re-measured.
Nursing homes were chosen for study because the QIO program was the only coordinated national quality improvement effort for these providers during this time period. “The question of the value of work in this setting is particularly important because this was a new project for the QIO program,” said IPRO’s Hartman. “And a priority for CMS.”
Estimates of CMS’ investment in the QIO program were calculated based on the total reported cost of QIO efforts in nursing homes by QALY at each assumed attribution level. The analysis was stratified into three levels, each assuming a percent of overall improvement that could be attributed to QIO interventions: 50 percent, 75 percent, and 100 percent.
With more than 20 years’ experience in health care quality improvement and evaluation, IPRO holds major contracts with state and federal governments to review the cost and quality of services provided to Medicaid recipients, Medicare beneficiaries, and patients enrolled in managed care organizations. Based in Lake Success, New York, IPRO also holds contracts with private-sector clients to improve the quality of privately financed services.