Medicare Quality Improvement Organizations (QIO) Program
Sponsor
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS).
Description
Under the direction of CMS, the QIO program consists of a national network of 53 QIOs responsible for each U.S. State, territory, and the District of Columbia. QIOs work with consumers, physicians, hospitals, and other caregivers to refine care delivery systems to make sure patients get the right care at the right time, particularly among underserved populations. The program also safeguards the integrity of the Medicare trust fund by ensuring payment is made only for medically necessary services, and investigates beneficiary complaints about quality of care.
For the QIOs' current (2002–2005) contract cycle, CMS has expanded performance expectations to encompass two additional health care settings—nursing homes and home health agencies.
Data Collection
Data are collected by the national network of 53 QIOs responsible for each U.S. State, territory, and the District of Columbia according to data collection tools developed by QIOs or related organizations. The systematic random sample size varies among years and measures. For example, in the 2002 data, all measures have up to 600 records per State; in the 2000–2001 data, acute myocardial infarction and pneumonia measures have up to 750 records per State, and the heart failure measures have up to 800 records per State.
Primary Content
Current national priorities include four healthcare settings: nursing homes, home health agencies, hospitals and physician offices. QIO measures included in the NHQR are hospital settings, including those related to acute myocardial infarction, heart failure, and pneumonia.
Population Targeted
Medicare beneficiaries as required for the relevant measure.
Demographic Data
Age, race, gender.
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