Medicare Consumers and Quality Innovation Networks

Medicare consumers are entitled to high quality health care. It is therefore the mandate of the BFCC to ensure that Medicare consumers. The body is responsible for managing all the complaints of Medicare consumers. They also ensure quality of care reviews, making sure that there is consistency in the whole review process and, at the same time taking into consideration all the factors which are vital for their consumers and clients. BFCC also deal with cases where the clients and consumers are appealing the decision by a health care provider to discharge them (the patients) from the hospitals. Two BFCC are responsible for serving fifty states together with three territories. These states and territories are divided into five main regions.

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Quality Innovation Network (QIN)-QIOs

Quality Innovation Networks are responsible for bringing together all the beneficiaries, providers and consumers of Medicare. They facilitate data-driven initiatives which increase the safety of patients, launch initiatives which make communities healthier, coordinate and corporate post-hospital care services and enhance clinical quality. Quality Innovation Networks serve between two to six states and, are thus able to promote excellent practices. They promote the spread and growth of better care and, at the same tome ensure that local conditions and cultural factors are accommodated.

CMS relies on Quality Improvement Organizations to enhance the quality of health care for its clients and consumers. It is a prerequisite for all QIOs under Section 1152-1154 of the Social Security Act. Quality Improvement Organizations are an integral part and resource of the CMSs. This is because they enhance the quality and the efficiency of the health care provided by Medicare. QIOs and CMS have played a very crucial role in enhancing national efforts through motivating providers in improving the quality of health care and, its outcome.

It is important to note that QIOs are private organizations. However, they are non-profit organizations are staffed by doctors together with other health care professionals. These doctors are professionally trained to:

They review the medical care

They assist the Medicare beneficiaries with complains about the quality of care

They put in place mechanisms which improve and enhance the quality of care throughout the spectrum of care offered by Medicare.

The Medicare Program has established several areas which the Quality Improvement Organizations needs to focus on and lay more emphasis on. Some of these fields include; clinical and non-clinical measures offered in nursing homes, home health agencies and physician services. The QIO program is now under the ninth SOW. The ninth SOW is concerned with the improvement of quality of care for Medicare consumers who transition among care services.

In as much as there has been growth and evolution of Quality Improvement Organizations from when they were launched in 1982, their main role has always been the protection and promotion of quality and efficient services being offered to Medicare beneficiaries. However, to function even better and more effectively, QIOs will have to integrate and incorporate physicians and hospital senior management into their quality improvement initiatives.

References

Strating SMH, Nieboer AP, Zuiderent-Jerak T, Bal RA. Creating Effective Quality-Improvement

Collaboratives: A Multiple Case Study. BMJ Quality & Safety. 2011;20(4):344-350

Mills PD, Weeks WB. Characteristics of Successful Quality Improvement Teams: Lessons from

Five Collaborative Projects in the Vha. Joint Commission journal on quality and patient safety. 2004;30(3):152-162.

Jackson GL, Powell AA, Ordin DL, et al. Developing and Sustaining Quality Improvement

Partnerships in the Va: The Colorectal Cancer Care Collaborative. Journal of general internal medicine. 2010;S1:38-43.