NMMRA’s 9SOW Under the Direction of CMS

The New Mexico Medical Review Association (NMMRA) began work on the Centers for Medicare & Medicaid Services (CMS) Ninth Statement of Work (9SOW) on Aug. 1, 2008. In February 2011, NMMRA received notification from CMS that its Quality Improvement Organization (QIO) contract will be non-competitively renewed for the 10SOW, scheduled to begin Aug. 1, 2011.

Under the direction of CMS, the QIO Program consists of a national network of 53 QIOs, responsible for the 50 U.S. states, the District of Columbia, Puerto Rico, and the Virgin Islands. QIOs work with consumers, health care providers and health plans, and industry stakeholders and other partners to refine care delivery systems to make sure patients get the right care at the right time, particularly patients from underserved populations. QIOs also help safeguard the integrity of the Medicare Trust Fund by investigating beneficiary complaints about quality of care and using the complaints as a basis for implementing targeted quality improvement initiatives with individual health care providers. QIO contracts with CMS run in three-year cycles. NMMRA focused on these main “Theme” areas during its 9SOW contract period: 

• Beneficiary Protection – reviewing the quality of care provided to beneficiaries and implementing quality improvement activities as a result of case review activities
• Patient Safety – working with hospitals and nursing homes to improve performance on a set of important processes and results that will reduce patient risk factors
• Prevention – improving immunization rates for influenza and pneumonia as well as key cancer screenings

• Adoption of value-driven health care
• Supporting the adoption and use of health information technology
• Reducing health care disparities

Medicare’s QIO Program demonstrates CMS’ commitment to consistent, high-quality care for Medicare beneficiaries across the country. The Program—originally known as the Utilization and Quality Control Peer Review Organization (PRO) Program—was created by the Social Security Act, as amended by the Peer Review Improvement Act of 1982. The Program’s statutory mission is to improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries. In the early years, PROs conducted medical record reviews to ensure that Medicare was paying for medically necessary care, while doing limited quality improvement work in the form of patient case reviews. In the early 1990s, the PRO Program evolved into the QIO Program following a landmark study of the Program by the Institute of Medicine, and was given a significantly enhanced mission to drive health care quality improvement. NMMRA has served continuously as the state’s only federally contracted PRO or QIO since 1984.

For more information about the success of NMMRA's work as the QIO for New Mexico during the 9SOW through August 2010, see the report 2009-2010 New Mexico Health Care Providers and NMMRA Working Together to Improve the Quality of Care.