CMS Announces Changes to QIO Program

The Centers for Medicare and Medicaid Services (CMS) on May 9 awarded Ohio-based KEPRO the Beneficiary and Family-Centered Care (BFCC) Quality Improvement Organization (QIO) Program contract for Texas, 32 other states, and the District of Columbia.

CMS stated in a news release KEPRO "will be responsible for ensuring consistency in the review process with consideration of local factors important to beneficiaries." The agency also said the award is part of a restructuring effort "to gain efficiencies, to eliminate any perceived conflicts of interest, and to better address the needs of Medicare beneficiaries using BFCC QIOs to focus on providing patients a voice through conducting quality of care reviews, discharge and termination of service appeals, and other areas of required review in various provider settings."

The selection of KEPRO and Maryland-based Livanta, LLC — which will represent 17 states, Puerto Rico, and the Virgin Islands — is phase one of restructuring, aimed at allowing the contractors to "support the program's case review and monitoring activities separate from the traditional quality improvement activities of the QIOs."

In the second phase — expected in July — CMS will award contracts to organizations that will work directly with physicians, hospitals, other health professionals, and communities on data-driven quality initiatives to improve patient safety, reduce harm, and improve clinical care and transparency at local, regional, and national levels.

CMS will introduce the program changes Aug. 1.

TMF Health Quality Institute Director of Communications and External Relations Emilie Fennell notes the BFCC QIO contract award pertains only to the review portion of the QIO program. 

She says CMS has made significant changes to its national QIO program. 

"The biggest change is there will be two new types of QIOs, and organizations are not allowed to serve as both types of QIO," Ms. Fennell said.

She clarifies BFCC QIOs will be responsible for protecting Medicare patients by reviewing individuals' concerns about their care. Because TMF pursued the quality improvement portion (phase two) of the Medicare QIO contract, the organization could not pursue the case review contract. 

"TMF Health Quality Institute has elected to focus on quality improvement technical assistance. This contract is scheduled to be awarded in July, and we look forward to building on TMF's decades of quality improvement work in the state," she said.

Action, June 2, 2014