Changes sought to tech rules for Medicare quality groups

Medicare is setting new performance goals for organizations that help doctors adopt information technology.

By David Glendinning, AMNews staff. Nov. 15, 2004.

Washington -- Physician practices in select states are being recruited by Medicare quality improvement organizations that are helping them adopt health information technology. But some stakeholders worry that new proposed government rules, if left unchanged, could confuse these efforts.

The Centers for Medicare & Medicaid Services recently proposed new rules for the nation's QIOs, which will contract with the agency for a new three-year term that starts in August 2005. The guidelines cover everything that the quality improvement groups do, from giving physicians advice on adopting disease management programs to promoting organizational changes within nursing homes that can lead to better patient outcomes.

As part of the free consulting services that they offer to physicians and other Medicare participants throughout the country, the firms are assisting doctors in implementing health information technology in an effort to optimize practice workflow, increase patient safety and lower costs to the federal government. The QIOs in Arkansas, California, Massachusetts and Utah are roughly halfway through a Medicare pilot project in which the groups are assisting small- to medium-sized physician practices that are good candidates for upgrading to electronic health records.

CMS anticipates that the initiative will serve as a framework for expanding such a service to one out of every 10 physician offices billing Medicare in each state.

The agency aims to broaden greatly the scope of responsibilities that QIOs will have in promoting IT innovations and demonstrating their usefulness through improved outcomes. Physicians who take advantage of the organizations' services will be asked to show that the assistance they receive is working, while QIOs will be required to secure specialized subcontractors that will shoulder some of the added work of helping doctors.