Quality Improvement Organizations Improve Care for Medicare Consumers

June 24, 2014

New CMS data shows QIOs are instrumental in reducing hospital readmissions and healthcare associated infections.

Topeka, Kan. – New data from the Centers for Medicare & Medicaid Services (CMS) show that Quality Improvement Organizations (QIO) have played a vital role in reducing hospital readmissions and healthcare associated infections by working closely with providers. Nationally, QIO and provider partnerships have prevented more than 95,000 hospitalizations and 27,000 hospital readmissions among Medicare consumers. From October 2010 to March 2013, CMS data indicate that hospital readmissions among Medicare beneficiaries declined by 13.22 percent in QIO communities, compared to a national drop of 12.55 percent. Similarly, hospital admissions also declined further in QIO communities—by 8.39 percent vs. 8.12 percent nationally—pointing to the efforts of QIOs as an important lever in improving healthcare quality nationwide.

In Kansas, hospital readmissions declined by 14.69 percent and hospital admissions declined 9.42 percent. To help reduce readmissions rates, the Kansas Foundation for Medical Care (KFMC) is working statewide and with coalitions in Hays, Kansas City, Topeka and Wichita. Providers have implemented many evidenced-based interventions across the care continuum and within their own facilities to achieve common goals.

By improving care transitions—when patients move from one care setting to another, such as from a hospital to their home—these reduced hospitalizations resulted in a cost savings of nearly $1 billion nationally. While progress has been made nationwide to improve care transitions and reduce the number of patients who return to the hospital within 30 days, CMS’ findings indicate that readmissions have been reduced further in communities where QIOs play an active role.

Improving care transitions is just one area of measurable improvement attributed to a national collaborative effort. In intensive care units and other hospital units in more than 800 facilities nationwide, QIOs provide assistance to help reduce healthcare associated infections (HAIs).

In Kansas, KFMC has partnered with the Kansas Department of Health and Environment (KDHE) and other healthcare providers to address Clostridium difficile infections (C. diff). Seven facilities in the state have joined forces to create the Kansas Clostridium difficile Prevention Collaborative. This collaborative is working to reduce C. diff infections through awareness, education, sharing best practices and training. Early results have shown a 16.5 percent relative improvement rate in reducing the number of hospital onset C. diff infections. All participating facilities have strengthened antimicrobial stewardship programs by formalizing antimicrobial stewardship policies, expanding team members and/or implementing alternative treatment or environmental disinfection options. Representatives from KFMC and KDHE were selected to present this collaborative at the national Association for Professionals in Infection Control and Epidemiology (APIC) annual conference.

"Our partnerships with other statewide organizations and providers are key to this success," said Sarah Irsik-Good, MHA, KFMC Director of Quality Improvement. "We strive to be a catalyst for innovation and inspire collaboration to address healthcare challenges in our state. The success of these two programs is evidence that both are vital to creating a positive healthcare environment for our Medicare consumers in Kansas."