Quality Improvement Organizations Provide Support to More Than Half of Hospitals but Overlap With Other Quality Improvement Programs

WHY WE DID THIS STUDY

Past work by the OIG and others raised concerns about Quality Improvement Organizations (QIOs), including duplication with other quality improvement efforts. Between 2011 and 2014, CMS paid QIOs about $1.6 billion to improve health care for Medicare beneficiaries. During this time, CMS also spent nearly $500 million on two new quality improvement efforts, Hospital Engagement Networks (HENs) and the Community-Based Care Transitions Program (CCTP). Given QIOs' new 5-year, $4 billion contract and the importance of CMS's quality improvement objectives, it is crucial that CMS coordinate its resources to avoid duplication among its quality improvement efforts.

HOW WE DID THIS STUDY

We sent a questionnaire to a random sample of 410 Medicare hospitals asking whether they worked with QIOs or other quality improvement entities in 2013. We received a weighted response rate of 93 percent. We analyzed CMS's lists of hospitals that worked with QIOs, HENs, and the CCTP. Finally, we conducted site visits at three hospitals in two States and QIOs representing four States.

WHAT WE FOUND

In 2013, over half of hospitals participated with QIOs on quality improvement projects. All participating hospitals in our sample reported receiving benefits by working with QIOs. Eight out of ten participating hospitals also worked with other federally funded entities on the same topics as QIOs. Most participating hospitals also worked with non-Federal entities on the same topics as QIOs. 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.

WHAT WE RECOMMEND

The overlap among CMS's quality improvement efforts raises concerns about duplication of efforts and makes it difficult to attribute quality improvements to any one effort. Therefore, we recommend that CMS take additional steps to coordinate, and reduce overlap between, the QIO program and CMS's other quality improvement efforts. We also recommend that CMS determine the relative contribution of each of its quality improvement efforts. CMS concurred with our recommendations.