Medicare Quality Improvement Organization

The Medicare Quality Improvement Organization (QIO) Program is the largest federal program dedicated to improving health quality at the community level. QIOs in every state and territory, united in a network administered by the Centers for Medicare & Medicaid Services (CMS), have the flexibility to respond to local needs.

As Florida stakeholders and providers, we encourage you to actively contribute to the process of learning and, when appropriate, share ways to efficiently, effectively, and economically improve the quality of patient care for Florida’s Medicare beneficiaries. Likewise, FMQAI pledges to be stakeholder-centric, ensuring that each policy, action, and decision is made with an educated and strategic consideration of its potential impact on you. This collaboration calls upon all partners to convene, organize, motivate, and serve as change agents with us. Providers and quality stakeholders who participate in and collaborate with the QIO can do the following:

Deliver Beneficiary and Family Centered Care. QIOs fulfill CMS’ obligation to protect the rights of Medicare beneficiaries by reviewing complaints about quality and appeals denial or discontinuation of healthcare services.
Improve Individual Patient Care. QIO patient safety initiatives in hospitals will reduce central line-associated bloodstream infections (CLABSIs) by implementing the Comprehensive Unit Based Safety Program (CUSP), and then expand to encompass catheter-associated urinary tract infections (CAUTIs), Clostridium difficile and surgical site infections. All Medicare-participating hospitals will also receive QIO technical assistance for reporting inpatient and outpatient quality data to CMS.

In nursing homes, work initially targets pressure ulcers and physical restraints then evolves to address other healthcare-acquired conditions, such as falls, CAUTIs, and focus on care specific to dementia patients.

To decrease adverse drug events, QIOs are bringing clinical pharmacists, physicians, and facilities together in local Patient Safety Clinical Pharmacy Services Collaborative (PSPC), following the successful Health Resources and Services Administration (HRSA) model.
Integrate Care for Populations and Communities QIOs are bringing together hospitals, nursing homes, patient advocacy organizations, and other stakeholders in community coalitions. Goals are to build capacity for improving care transitions and to support the coalitionâ€™s success in obtaining grant funding through Section 3026 of the Affordable Care Act.
Improve Health for Populations and Communities QIOs are assisting physician practices that want to use their electronic health record system to coordinate preventative services and report quality measures to CMS. QIOs also partner with their local Health Information Technology Regional Extension Center (REC) to promote health IT integration into clinical practice.

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Medicare Contract Numbers: QIO: HHSM-500-2011-FL10C ESRD: HHSM-500-2013-NW007C