QIOs Helping to Prevent Readmissions and Improve Quality

When Quality Improvement Organizations (QIOs) and providers work together, the rate of hospital readmission is less than in areas where QIOs do not work with providers, according to the American Health Quality Association (AHQA). The data provided by the AHQA shows that this collaboration has prevented more than 95,000 hospitalization and 27,000 hospital readmissions among Medicare beneficiaries resulting in a cost savings of nearly $1 billion.  In addition, recent data shows that QIOs have helped improve care at nursing homes as well by reducing the uses of restraints and the rate at which pressure sores develop.

Readmission Reduction

From October 2010 to March 2013 readmission rates among Medicare beneficiaries declined by 13.22 percent when the provider worked with a QIO, reported the AHQA.  The readmission rate for Medicare beneficiaries for providers who did not work with a QIO declined by 12.55 percent.  Similarly the AHQA reported that overall hospital admissions for Medicare beneficiaries declined by 8.39 percent when the provider worked with a QIO as opposed to 8.12 percent reduction in hospital admissions for Medicare beneficiaries when the provider did not work with a QIO.

An earlier study in the Journal of the American Medical Association (JAMA) came to similar conclusions. That study found that rehospitalizations were cut in half when providers worked with QIOs. In these cases QIOs implemented strategies aimed at (1) developing effective community coalitions that work to help keep patients healthy; (2) develop standard transition process as patients move from one care setting to another; (3) transferring patient clinical information between providers in a timely fashion; and (4) helping patients and their family members become actively engaged in the transition from one care setting to another.   The study involved 6,800 hospitalizations and averted 1,800 rehospitalizations.


A QIO is usually a non-profit organization staffed by doctors trained in medical review;  ensures that services provided to Medicare beneficiaries are medically necessary, reasonable, effective, and economical; and that the services meet professionals accepted standards of care. QIOs have been around since the 1980’s and there is generally one QIO per state. QIOs, among other things, are required to establish Memoranda of Agreements with providers and health plans that are consistent with the goals of the Health Care Quality Improvement Program.  They are  also to implement quality improvement projects on a standardized set of quality indicators and initiate local projects to improve quality.

“QIOs work in close partnership with physicians, nurses, and other members of the interdisciplinary team across settings–forming a network that helps patients remain healthy long after they leave the hospital,” said Adrienne Mimms Vice President and Chief Medical Officer of Atlanta-based Alliant GMCF, the QIO for Georgia and president of the AHQA.

HAIs. A greater reduction in hospital acquired infections (HAIs) has been reported in areas where QIOs work with providers as well, according to the AHQA.  From February 2011 to August 2013, QIOs’ efforts resulted in a 53 percent reduction in central line associated blood stream infections.  In addition, hospitals that work with QIOs have reduced the total number of Medicare patient days in which a catheter was used by more that 85,000 days. A major source of HAIs is catheter associated urinary infections.

Improvements at Nursing Homes

In another QIO project the rate of pressure sore development in nursing homes has been dramatically reduced according to a report in McKnights. Nursing homes working with QIOs have achieved a 38 percent reduction in the rate of pressure sore development from 2011 to 2014.  The use of restraints in nursing homes working with QIOs has been reduced by 76 percent under a separate initiative involving 1,000 nursing facilities working with QIOs.

“As the rates of chronic disease increase and the baby boom generation ages, it’s essential that we improve the quality of health care provided to  America’s seniors,” said Todd Ketch, executive director of AHQA. “Quality Improvement Organizations have driven major improvements in the quality of care across the nation, and in the years ahead, our work with QIOs will focus on  coordinating patient care across settings, reducing health care associated infections, improving care for common conditions like diabetes and heart disease, and more,” said Patrick Conway, MD, MSc, Chief Medical Officer for CMS, and Deputy Administrator for Innovation and Quality.