Aug. 22—A recent $1.1 billion, three-year phase of an ongoing Medicare quality improvement program failed to spur the use of many clinical procedures it aimed to encourage, according to a recently released study.

The Mathematica Policy Research study examined the August 2008 and July 2011 phase of the Center for Medicare & Medicaid Services (CMS) Quality Improvement Organization (QIO) program. Mathematica researchers credited the program with expanding the use of just four out of 13 quality measures researchers examined. 

The CMS QIO program provided group education, consultations, feedback reports, and tools to help providers offer better health care to Medicare beneficiaries.

The phase of the QIO program studied by Mathematica aimed to help providers improve care in 12 focus areas. The researchers examined the extent to which quality measures were adopted in five of those focus areas.

Improvements found included a 34 percent reduction in surgery patients not receiving timely treatments to prevent blood clots; a 36 percent drop in patients lacking beta blockers before and after surgery; a 1 percent decrease in diabetes patient s left untested for urinary microalbumin; and a 51 percent drop in long stay nursing home patients placed in restraints.

No significant improvements were found in nine other measures. Unimproved areas included three measures of hospital patient safety (giving antibiotics to surgery patients, removing surgical site hair before an operation, and giving certain heart drugs); one nursing home measure for preventing pressure ulcers; one physician practice measure for constructing arteriovenous fistulas for hemodialysis; and four community measures to prevent rehospitalization.

The Mathematica authors theorized that QIO’s impacts were limited by several factors, including the presence of many other quality improvement initiatives and a lack of timely, accurate information for QIOs to use in developing their interventions.

In response to the study’s findings, the CMS made changes to the QIO’s next phase, according to the Mathematica authors. Changes included establishing better collaboration between QIOs to accelerate the pace of change and opening initiatives to all providers interested in participating.

Publication Date: Thursday, August 22, 2013