OASIS Alert

Quality improvement organizations are the latest wave in QI, and home health agencies can learn a lot from nursing homes when it comes to riding the QIO wave to improved patient outcomes.

QIOs are contractors with the Centers for Medicare & Medicaid Services whose primary mission is to work with health care providers to achieve clinical quality improvement, explains David Schulke, executive vice president of the American Health Quality Association. Nursing homes have inundated these organizations with requests for their services since CMS rolled out its quality improvement initiative for the industry. And the QIOs expect to see even more action once CMS' home health initiative settles in (see Eli's OASIS Alert, Vol. 3, No. 7, p. 77).

QIOs work with health care providers to establish quality systems, identify best practices, and develop systems to foster and maintain quality improvement, among other functions, explained Sandy Fitzler with the American Health Care Association, speaking at a recent AHQA teleconference.

While the QIOs' recent focus has been on nursing homes, CMS has mandated that the organizations begin reaching out to the home health industry "sometime next year on a national level," Schulke tells Eli. "Since most home care agencies probably don't have much experience with the QIOs, they're going to be undertaking some very significant and high-profile outreach to the home health agency community," he reveals.

And since there's a total of 53 organizations one for each state and territory HHAs should have no trouble finding one fairly close by. "They won't have to work with someone from across the country," Schulke assures providers.

Agencies that choose to enlist a QIO's help in their QI efforts should expect a team-based process, though each organization is free to blaze its own trail, says Schulke.

Given that there are so many providers out there, and only 53 QIOs, most are choosing to pool their efforts, Schulke explains.

For example, if one QIO receives requests from 10 agencies, the QIO will meet with those agencies as a group to develop an assessment tool each agency can use, Schulke says. Then the agencies go home, implement the tool, and reconvene to discuss the results.

"One of the neat things about the QIOs is they can share what they've learned from other health care providers," he reports. "But an even more direct way of speeding up that kind of learning is to have the QIO there with all the providers sharing information and ideas as they go along."

"It's more powerful to have more people offering ideas and experience, so that'll probably become a very popular model for working with HHAs," Schulke posits.

This approach has worked well for the nursing home industry, said Suzanne Weiss with the American Association of Homes and Services for the Aging, also speaking at the AHQA teleconference. There has been a give-and-take relationship between the QIOs and the nursing homes they serve, according to Weiss.

Providers are "eager" to have QIO staffers come to their facilities because "they see them as partners rather than as just inspectors," she reported.

Nursing homes have been so eager to enlist QIOs, in fact, that CMS needs to boost the organizations' funding to meet the high demand, Schulke says. Of course, that means obtaining approval from the Office of Management and Budget for the extra money, which will be no easy task, he worries.

Although there hasn't yet been much activity from home health agencies on the QIO front, that probably will "step up considerably as soon as OBQI becomes a mandate" sometime next year, forecasts Ann Howard with the American Association for Homecare.

In fact, Schulke expects home health agencies to respond with even more fervor than nursing homes have done. "We could easily see 50 or 60 percent of the HHAs in every state working with a QIO or hoping to," he predicts.

Editor's Note: If your organization would like to have AHQA give a presentation about the role of QIOs in home care, please contact Sylvia Gaudette at sgaudette@ahqa.org.