Who to Call to Get Real Help On Medicare
So you’re looking for help with Medicare, but getting lost in the government red tape? Or maybe you don’t even know where to begin. That’s where Quality Improvement Organizations come in.
Under the direction of Centers for Medicare & Medicaid Services, the Quality Improvement Organization (QIO) Program consists of a national network of 53 localized operations for each U.S. state, territory, and the District of Columbia. QIOs are quality check and customer relations combined, working with consumers and physicians, hospitals, and other caregivers to refine care delivery systems to make sure patients get the right care at the right time. They ensure payment is made according to the rules of Medicare, and they investigate beneficiary complaints about quality of care.
- Medicare QIOs help hospitals, physicians, nursing homes, and home health professionals improve clinical care by measuring quality and encouraging adoption of proven “best” clinical practices.
- QIOs work with recipients to increase awareness of quality of care data in major clinical areas.
- About 2/3 of the Medicare QIOs perform independent quality oversight/utilization review for state Medicaid programs. Many QIOs also perform independent external reviews for private health plans.
These agencies use clinical indicators to evaluate hospitals and other care facilities giving medical care. For example, the number of minutes it takes to administer certain drugs to heart attack patients or the percentage of people with diabetes who get regular retinal eye exams. QIOs measure how often care is delivered in accordance with these quality indicators. When an indicator shows that care falls short, QIOs collaborate with doctors, hospital personnel, and other health professionals to examine their practices and improve systems of providing care. QIOs provide suggestions based on successful improvement projects in other hospitals and clinics consistent with the medical literature. Whenever possible, they re-measure the indicators to find out if the quality improvement intervention succeeded.
QIOs are required to conduct individual case review in the following categories:
- Potential antidumping violations
- Assistants at cataract surgery
- Beneficiary complaints, notices, and appeals
- Hospital and Managed Care Plan notices of non-coverage
- Potential concerns identified during project data collection
- Hospital-requested higher-weighted diagnosis related group (DRG) adjustments
To find a QIO in your state please visit this site.
Filed under: Medicare, Medicare & Medicaid
I am executive producer of a film called THINGS YOU SHOULD KNOW BEFORE ENTERING THE HOSPITAL. I read your story about medical errors and thought your readers would like to know what I have been learning from patient safety experts … people need to become active participants in their healthcare in order to keep themselves safe from infection and medical error.
Patient safety experts agree that patients should be learning how to keep themselves and loved ones safe while they are in the hospital. Unfortunately, patients are avoiding taking the steps necessary to learn. The patient safety experts compare it to how we avoid writing our Last Will & Testament. I guess the thought of being hospitalized is just too scary for any of us to think about. However, I recently found out that 55% of all hospitalizations actually begin in the Emergency Room so being prepared is critical because you never know when you might be hospitalized. That is one of the reasons we made a film that helps people learn how to be safe. I had a good friend who suffered medical errors and when he told me what happened I realized I wouldn’t know how to keep myself safe. I figured that if I didn’t know how to keep myself safe while in the hospital there had to be hundred of thousands others that could use practical advice.
Our film was independently produced out of our own pockets to avoid being steered by a sponsor/funder. It was inspired by one of our team members who contracted a terrible infection due to medical error.
I so agree with Betty–and this blog. Every time my mother (who suffered with a heart condition, Alzheimer’s and Parkinson’s) would go into the hospital, it would set us back for months.
I had to stay vigilent because the staff simply would not give my mother her meds on time–or anywhere near time!
Now, anyone who deals with Parkinson’s knows that timing is crucial. PD meds allow a person to function–walk, eat, converse–and without it, life goes totally haywire.
Or–on more than one occasion, they tried to give my mother her entire meds for the day in one dose! If I hadn’t been there, I hate to think what would have happened.
They also tried to convince her to have exploratory surgery on her bowels–just months before she died–at the age of 92. I refused, and I had DPOA. She, nor I could handle that.
Caregivers and family members MUST stay with their loved ones as much as they can. Their loved one’s lives may just depend on it.
~Carol D.O’Dell
Author of Mothering Mother: A Daughter’s Humorous and Heartbreaking Memoir
available on Amazon and in most bookstores
www.mothering-mother.com