In QSO Memo 20-31, CMS reviews the new strategically refocused approach of the Quality Improvement Organizations (QIO) to assist in combating COVID-19 within facilities.

In November 2019, CMS took a major step toward improving quality for Medicare beneficiaries in nursing homes as well as rural and underserved communities by awarding contracts to 12 experienced, community-based organizations to serve as QIOs and focus on areas of immediate need as well as urgent healthcare priorities. With varying degrees of intensity, QIOs provide education and training to every nursing home in the country. All nursing homes across the country can take advantage of weekly National Infection Control Training that focuses on all aspects of infection control, prevention and management to help nursing homes prevent the transmission of COVID-19 in facilities and keep residents safe.

The QIOs are being deployed to provide technical assistance to nursing homes, which includes a targeted focus on approximately 3,000 low performing nursing homes who have a history of infection control challenges. Further, States may request QIO technical assistance specifically targeted to nursing homes that have experienced an outbreak. The QIOs help nursing homes identify what their greatest areas of infection control problems are, then create an action plan, and implement specific steps to establish a strong infection control and surveillance program in the nursing home. For instance, they train staff on proper use of personal protective equipment (PPE), cohorting residents appropriately and transferring residents safely. They monitor compliance with infection control standards and practices in the nursing home.

Donna Thorson from Comagine Health has provided the following information regarding the two types of QII referrals.

Quality Improvement Initiatives (QIIs)

A QII is a referral from either from the Centers for Medicare & Medicaid Services (CMS) or the Beneficiary and Family Centered Care (BFCC) QIO. CMS defines a QII as:

“any formal activity designed to support quality improvement that uses proven methodologies to achieve these improvements. The improvements may relate to safety, health care, health, and value, and may involve providers, practitioners, beneficiaries, and/or communities.”

There are two types of QIIs that we manage under Task 3:

• BFCC-QIO referrals – These QIIs originate from beneficiary complaints that were identified by the BFCC as a confirmed quality of care concern. These QIIs are not new to providers. The BFCC-QIOs have managed these types of confirmed concerns for many years.
• CMS referrals – These QIIs originate from recent survey deficiencies from a facilities’ last state or federal survey. This work is new as of April 23, 2020 and came as a direct result of the CMS response to the COVID-19 global pandemic. We refer to these QIIs as targeted response (TR) QIIs.

Please note, it is an expectation of CMS that providers respond to any written or telephonic request from Kepro or Comagine Health. Please alert your business office that all mail from Kepro or Comagine is to be directed to the current administrator, even if it has a previous administrators name on it.  These are time sensitive documents and need to be opened and addressed immediately.

Questions?

Contact:

Laura Hofmann, MSN, RN – Director of Clinical and Nursing Facility Regulatory Services
c: 425-231-4804