The widespread reform of the nation’s healthcare has trickled down to create significant changes for area healthcare providers; changes that begin this month.
The changes are underway where Qsource, Tennessee’s longtime Quality Improvement Organization (QIO), has spearheaded a partnership effort under the consortia name “atom Alliance” to win a five-state Quality Innovation Network (QIN)/Quality Improvement Organization (QIO) contract from the Centers for Medicare & Medicaid Services (CMS). Under provisions of Qsource’s five-year, $51 million dollar contract, atom Alliance will work to improve healthcare quality for Medicare patients and families throughout Alabama, Kentucky, Mississippi, Tennessee and Indiana.
The move comes as part of CMS’s two-phased restructuring of the traditional QIO program, which required organizations to bid on regional coverage areas and also required bidders to choose between two lines of work: separating beneficiary complaint, case review and monitoring activities from quality improvement technical assistance activities. Qsource and its atom Alliance chose to pursue the quality improvement work and, as of August 1, 2014, no longer works with providers on case review activities.
New Protocol in Place
CMS named two Beneficiary and Family-Centered Care (BFCC) QIO contractors to support the program’s case review. KEPRO, located in Seven Hills Ohio, will conduct case review activities for Tennessee and will be responsible for ensuring consistency in the review process with consideration of local factors important to beneficiaries. Qsource has provided the following notification to providers:
Beginning August 1, 2014, all current and future beneficiary quality review case work and appeals will be conducted by KEPRO.
Healthcare providers and Medicare beneficiaries must now contact KEPRO toll-free at 1 (844) 430.9504 for all appeal requests and Quality of Care concerns. All outstanding Higher-Weighted DRG medical record requests after the above date should be mailed to: KEPRO; Rock Run Center; 5700 Lombardo Center, Suite 100; Seven Hills, Ohio 44131. If you would like more information from KEPRO during the transition, call the Provider Helpline toll-free at 1 (800) 385-5080. http://www.keproqio.com/
These changes are part of the CMS QIO program transformation effort which aims to improve the effectiveness, efficiency, economy, and quality of care for Medicare beneficiaries.
If a patient’s case is currently under review or in process, please be assured that every effort has been made to ensure a seamless transition for Medicare beneficiaries with no disruption in case review services.
New Alliance Quality Improvement
The newly restructured QIN-QIO contract is part of an unprecedented overhaul of CMS’s Quality Improvement Organization (QIO) program and aligns with the goals of the National Quality Strategy’s (NQS) three broad aims to better care, better health and lower costs through improvement. Under the new structure, atom Alliance will work with healthcare providers and communities on multiple, data-driven quality initiatives to improve patient safety, reduce harm and improve clinical care. Organizational members of atom Alliance include AQAF (Alabama), IQH (Mississippi) and Qsource (Tennessee, Kentucky and Indiana).
The atom Alliance will focus on several key initiatives during the next five years, with an emphasis on the entire region’s rural health needs, according to Qsource Chief Executive Officer, Dawn FitzGerald.