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Medicare News
MEDICARE LOOKS FOR WAYS TO BOOST QUALITY CARE COMMENTS SOUGHT ON NEW PLAN FOR QUALITY IMPROVEMENT ORGANIZATONSThe Centers for Medicare & Medicaid Services today took another important step to assure that every patient receives the right care at the right time with a new proposal for its Quality Improvement Organizations (QIOs). "The Quality Improvement Organizations are a key part of our efforts to improve the quality of care in the nation's health care system," said CMS Administrator Mark B. McClellan, M.D., Ph.D. "We know there are areas where there are substantial gaps between known good practice and actual practice, and we know dramatic improvement is possible. We now have more opportunities than ever to close those gaps, so that every Medicare beneficiary gets the right care every time he or she receives medical treatment." QIOs are local organizations that, by law, contract with CMS to provide quality improvement assistance to health care providers, such as physicians, hospitals, nursing homes and home health agencies, and to health plans that contract with Medicare. To help the QIOs, CMS is proposing an 8th Scope Of Work (SOW), a plan that represents significant enhancements on previous QIO contracts in three respects:
Dr. McClellan said CMS, working with the QIOs, wants to see improvements that could transform the quality of life for Medicare beneficiaries. For example, 27 percent of people with Medicare did not receive annual flu vaccinations in 2002. Flu vaccines could prevent as many as 22,000 deaths annually, according to preliminary research of the available literature. Under this plan, QIOs will assist in closing the gap between poor performing nursing homes and those practicing "right care." The proposal focuses attention in four settings-nursing homes, home health agencies, hospitals, and physician offices-as well as protecting beneficiaries and the Medicare Trust Fund through work on appeals, beneficiary complaints, payment error and other case review activities. It moves beyond the current 7th SOW in the following respects:
These activities are a central part of CMS's overall strategy to improve the quality of health care services to Medicare beneficiaries. This multi-pronged approach includes helping consumers make decisions using timely and accurate quality of care information, and urging providers to improve quality using free assistance from the QIOs and through "pay-for-performance" demonstrations. Beginning early in 2005, the hospital quality data will be available on a consumer Website, Hospital Compare, at www.medicare.gov, or by calling 1-800-MEDICARE (800-633-4227). Currently, CMS publishes quality information on www.medicare.gov for Medicare and Medicaid-certified nursing homes and Medicare-certified home health agencies. # # #
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Centers for Medicare & Medicaid Services
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