The report cites a study from the HHS Office of Inspector General, which was prompted by concerns related to quality improvement organizations. Between 2011 and 2014, CMS paid quality improvement organizations about $1.6 billion to improve healthcare for Medicare beneficiaries, according to the study. CMS also spent nearly $500 million on two new quality improvement efforts — Hospital Engagement Networks and the Community-Based Care Transitions Program — during that same time period.
“Given QIOs’ new five-year, $4 billion contract and the importance of CMS’ quality improvement objectives, it is crucial that CMS coordinate its resources to avoid duplication among its quality improvement efforts,” the study reads.
The study found more than half of hospitals participated with QIOs on quality improvement projects in 2013, and all participating hospitals in the study sample reported receiving benefits by working with QIOs.
“Eight out of 10 participating hospitals also worked with other federally funded entities on the same topics as QIOs. Most participating hospitals also worked with nonfederal entities on the same topics as QIOs,” the study reads. “Data problems and timing of other CMS quality improvement efforts hampered QIOs’ ability to target eligible hospitals and avoid duplicating those efforts. QIOs reported problems in key CMS data for recruiting hospitals for infection and readmissions projects. QIOs were already recruiting hospitals when CMS awarded HEN contracts and the CCTP agreements.”
Therefore, the OIG recommended that CMS “take additional steps to coordinate, and reduce overlap between the QIO program and CMS’ other quality improvement efforts” and “determine the relative contribution of each of its quality improvement efforts.”
CMS concurred with the recommendations.
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