- CMS wants to roll various Medicare quality improvement programs including Quality Improvement Networks and Organizations (QIN-QIOs), End Stage Renal Disease (ESRD) Networks and Hospital Improvement Innovation Networks (HIINs) into a single contract worth up to $25 billion.
- The program, dubbed Network of Quality Improvement and Innovation Contractors, will award multiple organizations Indefinite Delivery/Indefinite Quality contracts with a 10-year ordering period.
- Through these contracts, CMS hopes to accumulate a number of contractors capable of scaling their quality improvement efforts in settings and programs across the healthcare spectrum.
This new initiative ultimately seeks to reduce what the industry widely considers to be an overwhelming quality reporting burden, while providing a means of better evaluating projects. But effort also has potential to cause some disruptions for groups already involved in Medicare quality improvement that will now find themselves under a single, large contract.
For instance, Modern Healthcare reports that current Quality Improvement Networks and Organizations might not be able to "conduct claims audits due to new duties under NQIIC." CMS and hospitals prefer QIO claims audits over Recovery Audit Contractors claims audits, as QIO audits are often overseen by clinicians.
Responding to provider concerns about current performance measurement policies, the American College of Physicians recently published an analysis of the Merit-based Incentive Payment System (MIPS) that found the majority of measures for ambulatory internal medicine are "not valid."
That analysis found physician practices spend about $40,000 a year per physician to report on performance, with a majority of physicians claiming current measures fail to adequately capture the quality of care they provide patients.
A Medical Group Management Association survey published last year also found that group practices feel MIPS is too complex and hinders patient care. Nearly three-fourths of those surveyed said MIPS doesn't support clinical quality priorities and found it to be "very" or "extremely" complex.
Removing regulatory burdens and offering providers more choices are some of Trump administration's healthcare goals, and CMS is well aware of problems with reporting data. The agency last year asked clinicians to take part in a year-long study looking into the burden of reporting data for MIPS and has been looking to overhaul MACRA and remove reporting barriers for quality measures.
"CMS is making great strides in improving care for Medicare beneficiaries," the agency said in a statement. "However, much more work must be done to improve the quality and efficiency of the U.S. healthcare system."