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The Centers for Medicare & Medicaid Services (CMS) has released its annual Quality Improvement Organization (QIO) Program Progress Report for 2016, which provides updates on the activities of the QIO Program. In this report are the accomplishments of both the Beneficiary and Family Centered Care QIOs (BFCC-QIOs) and the Quality Innovation Network QIOs (QIN-QIOs).
During 2016, the BFCC-QIOs completed more than 448,200 reviews and saved the Medicare program $20 million processing Higher Weighted Diagnosis-Related Group (HWDRG) reviews. More than 328,800 discharge appeal reviews were completed, resulting in 68,200 beneficiaries not being discharged when they needed continued care. Appeal types include skilled nursing facilities, acute rehabilitation, hospital, and hospice discharges as well as admission denials. BFCC-QIOs performed more than 29,050 quality of care reviews, which identified opportunities for quality improvement in various settings. Then the BFCC-QIOs partnered with the QIN-QIOs to implement more than 730 quality improvement initiatives to address the identified concerns.
QIN-QIOs were successful in achieving meaningful results in the areas of care coordination, diabetes care, and nursing home care.
CMS leaders were awarded the Samuel J. Heyman Service to America Medal (SAMMIE) as Federal Employees of the Year for achieving major improvements in hospital patient safety in collaboration with diverse public-private sector partners such as QIOs.
Learn more about the impact of the QIO Program in your state.
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Immediate Advocacy is an informal process in which KEPRO acts as a liaison for a Medicare beneficiary or his or her representative to quickly resolve a verbal complaint. Below is an example of a KEPRO success story.
initiative, CMS will prevent fraud, fight identity theft, and protect essential program funding and the private healthcare and financial information of our Medicare beneficiaries. 
