Quality Improvement Organization Information

A Quality Improvement Organization (QIO) is a group of health quality experts, clinicians, and consumers organized to improve the care delivered to people with Medicare. QIOs work under the direction of the Centers for Medicare and Medicaid Services (CMS) to assist Medicare providers with quality improvement and to review quality concerns for the protection of beneficiaries of the Medicare Trust Fund.

QIOs are private, mostly not-for-profit organizations staffed by doctors and other healthcare professionals trained to review medical care, help beneficiaries with complaints about the quality of care, and implement improvements in the quality of care available throughout the spectrum of care. CMS has designated two QIOs for each state. One QIO will handle complaints and case reviews while another QIO will provide technical assistance to support healthcare providers and suppliers. For more information, visit CMS Quality Improvement Organizations.

Beneficiary and Family-Centered Care (BFCC) Quality Improvement Organization (QIO)

Beneficiary and Family-Centered Care - Quality Improvement Organizations (BFCC-QIO) improve healthcare services and protect beneficiaries through expeditious statutory review functions, including complaints and quality of care reviews for people with Medicare. The BFCC-QIO manages all beneficiary complaints, quality of care reviews, EMTALA, and other types of case reviews to ensure consistency in the case review process while taking into consideration local factors important to beneficiaries and their families including needs for general quality of care, medical necessity, and readmissions.

There are two ways a patient or family member may file a complaint about the quality of care. A complaint may be filed with the BFCC-QIO. The BFCC-QIO will then conduct a quality of care review. The review focuses on improving the quality of care processes for all beneficiaries and is independent of the state licensing and certification process.

For licensed or certified health care facilities, a complaint may also be filed with the IDOH Licensing and Certification Program. State nursing surveyors then conduct a survey of the facility to determine compliance with state licensing and federal certification regulations. See Reporting a Complaint about a Health Care Facility for more information.

The BFCC QIO for Indiana is:

Quality Improvement Network (QIN) Quality Improvement Organization (QIO)

Quality Improvement Network-Quality Improvement Organizations (QIN-QIO) improve healthcare services through education, outreach, sharing best practices, using data to measure improvement, working with patients and families and convening community partners for communication and collaboration. QIN-QIOs also work to improve the quality of healthcare for targeted health conditions and priority populations and to reduce the incidence of health-acquired conditions to meet national and local priorities.

The Quality Improvement Network-Quality Improvement Organization (QIN-QIO) will work with healthcare providers on data-driven quality initiatives. QIN-QIO projects will be based in communities, healthcare facilities, and clinical practices. The organization will work on strategic initiatives such as reducing healthcare-associated infections (HAI), hospital readmissions, medical errors, falls, pressure ulcers, using health information technology, reducing cardiac disease and diabetes, reducing healthcare disparities, and care coordination. QIN-QIOs will also provide technical assistance for improvement in CMS value-based purchasing programs.

The QIN-QIO for Indiana is: