The Centers for Medicare & Medicaid Services (CMS) announced today that the Health Services Advisory Group (HSAG) has begun working with beneficiaries and providers to protect the quality of care available to citizens of California.

The HSAG now serves as the Medicare Quality Improvement Organization (QIO) in California  , and provides free expert resources to selected health care providers to improve quality and safety of care and transform the way health care is delivered locally. 

The HSAG, and other QIOs across the country, also work with Medicare beneficiaries and their advocates every day to help them resolve complaints or appeals they have about the quality of care they receive from Medicare providers.  QIOs strive to address beneficiaries’ concerns while working with health care providers to help them provide better care in the future.  Learn more about this important function of the QIOs at www.medicare.gov/Ombudsman/resources.asp.

“We look forward to working with the Health Services Advisory Group to improve the health care provided to Medicare beneficiaries in California,” said Barry M. Straube, M.D., CMS chief medical officer and director of the agency’s Office of Clinical Standards & Quality.  “Our goal in working with all QIOs, including HSAG, is to make sure that they serve as a valuable resource to this state in making sure that patients get the right care at the right time every time.”

The HSAG is already working with providers to improve the quality of health care in California by providing direct quality improvement support to nursing homes, hospitals, and physicians’ offices.  They are also receiving quality of care complaints and appeals from beneficiaries.  Specifically, HSAG is working to:

• Protect the rights of Medicare beneficiaries. HSAG will review the medical circumstances surrounding complaints about quality of care, and use this information to work with providers to improve care.  The QIO–and CMS–will use this information to develop quality improvement projects to address the underlying reasons behind the complaints
• Make care safer across the health system.   HSAG will work to reduce the number of avoidable pressure ulcers and use of physical restraints in nursing homes and hospitals.  Also for hospitals, the QIO will focus on efforts to address surgical care improvement, reducing the incidence of drug-resistant staph infections (such as MRSA) in hospitals, and improving drug safety.
• Prevent serious acute and chronic conditions.   HSAG will work to improve vaccination rates for flu and pneumonia, encourage the use of colorectal and breast cancer screening tests, and support health care professionals in using electronic health records to better manage patient care.

Previously, Lumetra served as the Medicare QIO for California  .  Through a competitive process, CMS awarded the state QIO contract to HSAG.  Now that Lumetra’s contract with CMS has ended, HSAG is now equipped to handle all aspects of QIO work for the state, and is the only entity authorized by CMS to serve as California ’s QIO. 

“We very much appreciate the contributions that Lumetra has made towards improving the quality and efficiency of health care processes and outcomes, as well as safeguarding patient rights and the Medicare Trust Fund,” said Dr. Straube.  “Ultimately, through an open, transparent competitive process, CMS awarded this important work to the HSAG as part of our effort to ensure that our QIO Program delivers maximum benefit to the health and safety of Medicare beneficiaries and the interests of taxpayers.”

Medicare beneficiaries who have concerns about the quality of care they receive from Medicare providers or who wish to appeal premature discharges from the hospital should contact the QIO for their state.  California beneficiaries may contact HSAG at 1-800-841-1602 (or 1-800-881-5980).  Beneficiaries in other parts of the country should call 1-800-MEDICARE or visit www.medicare.gov to obtain contact information about the QIO in their state.

The QIO Program, created by law in 1982, provides  for the award of three-year contracts to 53 organizations throughout the country—one in each state as well as the District of Columbia, the Virgin Islands, and Puerto Rico—to improve the quality, safety, efficiency, and economy of health care services delivered to Medicare beneficiaries and the public at large.  To learn more about the QIO Program, visit www.cms.hhs.gov/qualityimprovementorgs.

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