Medicare's Quality Improvement Organization Program Value in Nursing Homes

By Shih, Anthony; Dewar, Diane M. et al. | Health Care Financing Review, Spring 2007 | Go to article overview

Medicare's Quality Improvement Organization Program Value in Nursing Homes


Shih, Anthony, Dewar, Diane M., Hartman, Thomas, Health Care Financing Review


INTRODUCTION

The Medicare Program currently covers an estimated 42.1 million elderly and disabled beneficiaries (Centers for Medicare & Medicaid Services, 2005). To help improve the quality of care delivered under Medicare, CMS (2005) operates a national network of 53 QIOs responsible for each U.S. State, Territory, and the District of Columbia. One key aspect of the QIOs' responsibilities is to "... improve quality of care for beneficiaries by ensuring that beneficiary care meets professionally recognized standards of health care ..." (Centers for Medicare & Medicaid Services, 2005). Since the early 1990s, the QIOs' primary approach has been to achieve this goal through the provision of QI technical assistance to health care providers (e.g., hospitals, nursing homes, physician practices, home health agencies, and managed care plans) in a collaborative environment (Jencks and Wilensky, 1992; Jencks, 1995).

Although there has been increasing literature examining the effectiveness of QIO work, there have been no studies on the value of their work. That is, if the program is effective in improving care, are the benefits worth the investment in the program by CMS? This article seeks to answer that question using cost-utility analysis, where the benefits are measured in QALYs gained. QALYs are not restricted to changes in the quantity of life, and allow us to measure changes in the quality of life. The QALY measure on values or weights that reflect the desirability of health States emphasizes the critical role of consumer preferences in valuing outcomes (Drummond et al., 2005). Translating gains in health care quality potentially attributable to QIO work into QALYs facilitates comparison to other health care interventions that are currently promoted in the U.S. health care system whose benefits are also measured in QALYs. (1) This article does not seek to answer the effectiveness question, but rather presents results based on a range of reasonable assumptions regarding QIO effectiveness.

QIOs work on multiple QI projects in different health care settings. They were asked to assist nursing homes across the country to improve quality of care as measured by CMS' publicly reported nursing home quality measures, which were launched in October 2002. The scope of activities included educational conferences, collaborative learning sessions, distribution of QI materials, and individual technical assistance provided to nursing homes. The question of the value of QIO work in this setting is particularly important because this was a new project for the QIO program, and a priority area for CMS.

METHODS

Quality Measures

QIO nursing home QI activities began in July 2002. To track changes in quality-of-care, we utilized the CMS nursing home quality measures for national public reporting from 2002-2005. The measures are derived from the resident-level minimum data set (MDS) that are submitted by nursing facilities to their respective State health departments. These measures have been validated (Morris et al., 2003) and endorsed by the National Quality Forum, and facility-specific results are reported publicly on CMS' Nursing Home Compare Web site at: http://www. medicare.gov/NHCompare/home.asp).

Although QIOs were asked to support improvement in all of the quality measures, each QIO was asked to choose three to five measures to focus on in their respective States. To be more conservative in our assumptions about improvements due to QIO activity, we included only the top five measures across the country as areas of focus. These measures are summarized in Table 1. The baseline measurement period was the 2nd quarter 2002. The remeasurement period for this study was the period used by CMS to evaluate QIOs on their performance-based contract, the 2nd quarter 2004. The national performance data during the baseline and remeasurement periods were provided by CMS.

Estimating QIO Impact

For measures that improved during the study period, we estimated the number of residents affected by the improved rate using the national denominator for each measure at the time of remeasurement. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Note: primary sources have slightly different requirements for citation. Please see these guidelines for more information.

Cited article

Medicare's Quality Improvement Organization Program Value in Nursing Homes
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen
Items saved from this article
  • Highlights & Notes
  • Citations
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Search by... Author
    Show... All Results Primary Sources Peer-reviewed

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.