Is Healthcare Getting the Most from Quality Improvement Organizations?

Tuesday, February 12th, 2013
This post was written by Patricia Donovan

QIOs can help to support efforts to reduce Medicare readmissions.

Hospitalizations and readmissions were reduced by at least 6 percent in areas of the country where quality improvement organizations (QIOs) made concerted efforts to improve care transitions from hospitals to the home or other post-acute facilities, according to findings published last month in Journal of the American Medical Association (JAMA).

The study shows that hospitalizations and rehospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interventions that engaged whole communities to improve care than in comparison communities, according to a press release from Qualis Health, one of 14 state-based QIOs that acts as the QIO for Idaho and Washington. Prior to a 2012 regionalization effort, each state had its own QIO.

This encouraging data suggests that the CMS-funded QIOs may be underutilized for community-based care improvement and the reduction of avoidable healthcare costs. In a new HIN report on avoiding CMS readmissions penalties, Dr. Amy Boutwell proposes several ways in which healthcare organizations can partner with QIOs to shore up care transitions, thereby reducing the likelihood of readmissions.

“Groupings of hospitals and of post-acute providers in regional geographies help to improve care transitions and care coordination across settings,” noted Dr. Boutwell, a physician and president of Collaborative Healthcare Strategies who also co-founded the Institute for Healthcare Improvement’s STAAR (State Action on Avoidable Rehospitalizations) Initiative. “Take advantage of the wealth of other programs and incentives that are coming out of the federal government in this domain.”

Request help from QIOs with data management, she suggests. Knowing one’s own data as well as one’s community partners are two essential steps in identifying weaknesses in care coordination efforts. “The QIO can run your data, which is especially helpful if you are an urban or a busy suburban market. They can show to you all of the transitions between your hospital and other settings of care that are Medicare providers, home health agencies and skilled nursing facilities.

“The QIO can also show you the frequency of transitions between all of these facilities as well as the directionality,” Dr. Boutwell continues. “For example, are you sending out a lot of patients from your hospital to the post-acute and are they sending you back a lot of patients? Wherever those arrows are coming back to you would indicate a high strategic opportunity to engage with those post-acute providers and start talking about the importance of not sending the patient back if there is any way to possibly avoid it in a safe and appropriate manner.”

Each state has a QIO under contract from CMS to help communities at their request improve their care transitions. The QIOs serve as the largest federal program dedicated specifically to improving healthcare quality at the community level.

Dr. Boutwell suggested some other federally funded programs that can provide assistance:

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