The American Medical Association, a number of other national provider associations, and 47 state medical societies are urging the Centers for Medicare & Medicaid Services to preserve federal funding for state-based quality improvement organizations.
Some of the nation's largest provider associations are asking the federal government to spare state-based quality improvement organizations from proposed funding cuts or significant reorganizations.
The American Medical Association, the National Rural Health Association, the American Health Care Association, and the American Health Quality Association have sent letters to the Centers for Medicare & Medicaid Services to call for maintaining its long-standing support of QIOs, which since 1984 have collaborated with physicians, hospitals and other providers to coordinate care for Medicare patients at hospitals, physicians' offices, long-term and post-acute care facilities, health clinics, and at home.
The AMA also circulated a sign-on letter to 47 state medical societies, all of whom said they opposed any cuts to QIOs.
CMS in May made a request for public comment on proposals to cut funding to many state-based QIOs and fund a few regional QIOs instead. "The need for QIOs has evolved from utilization review alone to convening complex local communities that can span state boundaries, particularly as health delivery systems become more horizontally and vertically integrated and new alliances form," CMS said in its request-for-comment letter.
"Now that the QIOs' role in healthcare quality improvement has changed, it is time to think about new and better ways to approach QIO work. Beginning in August 2014, we will launch the next round of QIO Program contracts with a new approach to essential program operations and the service areas for QIOs. In doing so, we hope to maximize program efficiency while improving the quality of care Medicare beneficiaries receive."
Mark Parkinson, president/CEO of AHCA, which represents more than 12,000 non-profit and proprietary skilled nursing centers, assisted living communities, sub-acute centers and homes, said that any changes that could potentially disrupt more than three decades of careful and structured collaboration between QIOs and local providers would prove counterproductive.
"For more than a decade, our skilled nursing members from across the country built trusted, productive working relationships with their QIO," Parkinson said. "Attempting to recreate these relationships with an organization operating several states away dismantles the progress the profession has made, and takes precious time and resources away from a currently beneficial system."
Parkinson said that federally funded but locally based QIOs work closely with local providers, consumers and stakeholders across the continuum of care in every state to ensure patient safety, adopt best clinical practices and improve systems of healthcare delivery.
QIO advocates point to a study in The Journal of the American Medical Association this year that found a 6% drop in both hospitalizations and readmissions among Medicare recipients because of the work of QIOs in 14 pilot communities.
The study found that targeted improvements facilitate care transitions and improve coordination as patients moved from one care setting to another. As a result, QIOs helped prevent about 6,800 hospitalizations and 1,800 readmissions per year. Advocates said that return visits are avoidable, yet cost the federal government billions of dollars each year, while funding the work of QIOs costs less than a dollar a month per Medicare beneficiary.
"While this CMS-funded work focuses on the quality of care provided to our nation's seniors, the program's learnings and successes to-date improve the care provided to Americans of all ages," said Adrienne Mims, MD, MPH, president of AHQA and medical director of Atlanta-based Alliant GMCF, the QIO for Georgia.
"Anyone who has ever been or will be a patient benefits, but we need to maintain the existing local infrastructure if we're to ensure the program continues to meet patients' unique needs, which can vary considerably from state to state. There's no evidence to show that a regional model will achieve better or even equivalent outcomes for patients."
AARP has also warned CMS against significant changes to the QIO program without first evaluating the proposed new approaches through pilot or demonstration programs to ensure there are no negative, unintended consequences.
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.