Civitas Survey Highlights Medicare Quality Improvement Organizations’ Impact and Future Needs
Civitas Networks for Health conducted a survey of 11 Medicare Quality Improvement Organizations (QIOs) to evaluate their accomplishments and suggest enhancements for ongoing Medicare quality improvement efforts. The survey covered achievements during the latest five-year contract cycle (2019-2024) for Quality Improvement Network (QIN-QIO) activities and a four-year span (2020-2024) for Hospital Quality Improvement Contractor (HQIC) initiatives.
Collectively, the surveyed QIOs generated significant Medicare savings, amounting to $4.7 billion over 2022-2024 by reducing preventable emergency department visits, hospital admissions, and 30-day readmission rates across 11 states. Additionally, nursing home-focused QIN-QIO activities in 20 states delivered $165 million in savings, demonstrating a $57 return for every dollar invested.
The report emphasizes the critical role QIOs play in supporting hospitals, nursing homes, and other healthcare facilities, particularly those serving high-need and rural populations. It warns that discontinuation of core QIO programs could create a gap in essential resources, as many small care facilities and critical access hospitals lack the capacity to fund similar services independently.
Recommendations from the QIOs include expanding their capacity to leverage digital tools and data interoperability by easing CMS-imposed barriers to data sharing with public and private health information exchanges. They also advocate for enhanced CMS support to facilitate more onsite, in-person training alongside virtual options.
Furthermore, QIOs call for investment in sustainability infrastructure to address systemic workforce challenges, such as low staff retention, through leadership training and workforce retention strategies integrated into hiring processes. The QIOs also propose formally recognizing "zero-baseline" hospitals that maintain zero harm rates in specific safety metrics to better target resources to high-risk facilities.
The survey highlights that sustained funding and contract continuity are crucial to preserving the gains achieved through QIO efforts and advancing Medicare quality initiatives. Increased emphasis on interoperability, technical assistance, and workforce development are identified as vital components for future program success.