CMS QIO Releases Scope of Work

CMS has released the Quality Improvement Organization (QIO) program’s 11th Scope of Work that will start August 2014.  The main changes are outlined below.  Click here for the section pertinent to skilled nursing facilities.  To review the entire QIO scope of work and all documents, click here. 

Skilled Nursing Facility 11th Scope of Work
(Task C.2:  Reducing Healthcare-Acquired Conditions in Nursing Homes section)

• Recruit 75% of SNFs in each state with oversampling of 1 STAR facilities
     o   QIOs must collect from all SNFs
      -Who participate, a signed statement that the nursing home will actively participate in the    Collaborative, including data submission and data sharing.
      -Who elect not to participate, a signed statement that they decline to participate and why.

• The QIN-QIO shall have a targeted focus on
     o   increasing mobility among long-stay residents,
     o   decreasing unnecessary use of antipsychotics in dementia residents,
     o   decreasing potentially avoidable hospitalizations,
     o   decreasing Health Care Acquired Infections (HAIs) such as Methicillin - resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C.Diff), and vaccinations, such as pneumonia and influenza,
     o   decreasing other Healthcare Acquired Conditions (HACs) such as: urinary tract infections, pressure ulcers, physical restraints, and ensuring an “injury and violence free living” environment as noted in the National Prevention Strategy, and
     o   improving resident satisfaction.

• The QIN-QIO’s efforts related to beneficiary satisfaction shall focus on the nursing home systems that impact quality, such as consistent/permanent staff assignment, communications, leadership, regulatory compliance, clinical models, and quality of life indicators.

• The QIN-QIO shall recruit residents/beneficiaries and their family-members for participation as a part of the QIN-QIO’s Peer-Coach activity. In addition, the QIN-QIO shall include residents/beneficiaries and/or family members in at least two quality improvement activities initiated or performed by the QIN-QIO under Task C.2.

• QINs will conduct two collaboratives: NNHQCC Collaborative(s) I and II shall commence in Year 1 and Year 3 of the contract term, respectively, and each Collaborative shall last for 18 months.
     o NNHQCC will use the Quality Assurance & Performance Improvement (QAPI) model as the framework for nursing home quality improvement.
     o QIN-QIO shall recruit nursing homes to act as “Peer-Coaches” for other nursing homes in the Collaboratives if they are a high-performing nursing home, defined as being in the top 10% of the National Nursing Home Composite Quality Measure (to be provided by CMS).
     o QIOs will work to attain a score of six or better on the National Nursing Home Composite Quality Measure (TBD).
     o Improve the rate of mobility among long-stay nursing home residents.
     o Reduce the use of unnecessary antipsychotic medication in dementia residents.

• The QIN-QIO shall create or engage with other Learning Area Networks such as, Advancing Excellence in America’s Nursing Homes Local Area Networks for Excellence (LANEs), Long Term Care Ombudsmen, nursing homes, HHS and CMS agencies, and others committed to nursing home excellence.