The 13 quality improvement organizations that are part of CMS' Quality Innovation Network are halting operations and laying off staff as they wait for the agency to renew their multimillion-dollar contract. The $960 million contract, which ended in mid-July, wasn't renewed and won't be until sometime between September and November, according to a CMS memo to the organizations last month.
The CMS didn't offer a reason in the memo for the delay in funding, but an agency spokeswoman said in an email to Project Japan that some of the work performed by the quality improvement organizations for the expired five-year contract isn't ending until Oct. 16. She said the agency is in the "process of a normal transition" to the next contract.
"During this transition, CMS is ensuring that important quality improvement work will not lapse and looks forward to working with QIN-QIOs to improve health outcomes for Medicare beneficiaries," the spokeswoman added.
But the quality improvement organizations argue operations are being affected as they are forced to lay off or furlough staff.
"We have this unprecedented funding lapse, and we don't know how long it's going to continue and every day it continues is another pin being removed from the infrastructure of this quality improvement program, which is supporting the entire Medicare program," said Alison Teitelbaum, executive director of the American Health Quality Association, which represents the 13 quality improvement organizations.
The Quality Innovation Network-Quality Improvement Organizations is federally mandated and nearly 50 years old. The organizations work with hospitals, outpatient clinics and home health organizations throughout the U.S. on initiatives to improve patient care and safety for Medicare beneficiaries.
While the contractors have experienced delays in funding before, it's never been this long, Teitelbaum said. The CMS has renewed the contract 11 times.
The agency instituted task orders during the contract hiatus but limited work to data gathering, medication safety, adverse drug event prevention and treatment of chronic kidney disease.
"Although (the task orders) include important work, it doesn't include any quality improvement activities such as technical assistance for providers and isn't funded at a level anywhere close to what is needed to prevent massive layoffs," Teitelbaum said.
The transition task orders have a $12 million budget, according to Teitelbaum.
The American Health Quality Association is currently gathering staffing information from the quality improvement organizations but Teitelbaum said members expect to lay off 10% of staff.
In 2017, the CMS said the work from the quality improvement organizations led to adverse drug event screenings for more than 2.3 million beneficiaries, a 26% reduction in anti-psychotic medication at nursing homes and more than 47,800 beneficiaries completing diabetes self-management education and support programs.
The funding delay also impacts the quality improvement organizations that are part of the agency's Beneficiary and Family Centered Care program, which manages complaints from Medicare beneficiaries.
In another memo, the CMS ordered those quality improvement organizations to not refer any quality improvement initiatives to the Quality Innovation Network organizations. The organizations from both programs often work together to address patient complaints.
"They have had to stop this piece of their work because of this lapse in funding in the QIN-QIO program and of course that is impacting what they are able to achieve and ultimately the beneficiary," Teitelbaum said.