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From Health Law Daily, October 1, 2014

CMS letter defends quality improvement program restructuring and addresses ‘transitional issues’

By Bryant Storm, JD

A letter defending the CMS restructuring of the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) program was sent from CMS to the American Hospital Association (AHA) in response to an AHA letter that expressed concerns about the QIO program restructuring. The letter acknowledged challenges that have been presented by the restructuring, including lags in appeal decisions and increased call center wait times. Through the letter, CMS informs AHA that it is aware of the issues and is working to correct each of the concerns raised by the AHA.

Restructuring. The QIO program is designed to ensure high quality care for Medicare beneficiaries by assisting providers with quality improvement measures and quality reviews. CMS restructured the BFCC-QIO program on August 1, 2014. Prior to the restructuring, the QIO program consisted of 53 QIO contractors that operated within each state and U.S. territory. The restructuring consolidated the amount of contractors into five BFCC regional QIO contractors. Following the restructuring, hospitals and beneficiaries identified issues with the new quality program design. Through a letter authored by Nancy Foster, Vice President of Quality and Patient Safety Policy at the AHA, the AHA notified CMS of several areas in which the BFCC-QIO program was lacking.

Transition. The problems identified by the AHA are characterized as “transitional issues” in the CMS response. Among those issues were AHA concerns about the slow speed of appeal decisions. In its response, CMS indicated that BFCC-QIO’s are hiring additional staff members, taking on additional customer service training, and increasing informational systems capacity in order to address the lag in appeals. The AHA also cautioned CMS that telephone call center wait times had seen significant increases since the restructuring. CMS responded to the AHA concerns by informing the AHA that BFCC-QIOs are hiring additional call center staff, improving phone routing, and enhancing phone triage prompts in order to deal with increases in call volume brought on by the restructuring.

Other efforts. CMS also addressed efforts it is taking to resolve data submission and confirmation problems associated with the migration of My QualityNet to the new QualityNet Secure Portal. CMS indicates that it is aware that some providers and vendors have experienced issues with the reporting system transition. The letter expresses that CMS is learning from the failures and is developing an improvement plan so that future outreach will function more smoothly. The letter thanks the AHA for its patience while CMS resolves the transitional problems and expresses the intention of CMS to expedite the resolution of those issues.

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