This article was contributed by the Beneficiary and Family Centered Care-National Coordinating Center.
Beneficiary and Family Centered Care-Quality Improvement Organizations (BFCC-QIOs) are important points of contact for people with Medicare. Why? They serve as advocates by helping Medicare beneficiaries, as well as their families and caregivers, exercise their right to high-quality health care by managing complaints and quality of care reviews, managing discharge appeals and providing Immediate Advocacy services.
Since 2014, KEPRO and Livanta, the two BFCC-QIOs serving all 50 U.S. states and three territories, have received a total of 709,874 calls through their Medicare beneficiary helplines. They have resolved 5,377 — or 33 percent — of Medicare complaints through the use of Immediate Advocacy, usually providing resolution within one to two business days.1
These results, as well as other successes and challenges, are highlighted in the regionally focused annual reports published by the BFCC-QIOs. The most recent reports cover August 1, 2016 to July 31, 2017. Reports include an overview of the top quality of care concerns for people with Medicare. Nationally, the top three concerns cited in the most recent reports were the following:
- Apparently did not establish and/or develop an appropriate treatment plan for a defined problem or diagnosis which prompted this episode of care
- Apparently did not carry out an established plan in a competent and/or timely fashion
- Apparently did not make appropriate diagnoses and/or assessments
Do top concerns vary from one state (or region) to another? Annual reports can provide the answers. Those interested in looking at state-level data can visit the QIO Program website to access the reports. Data include total number of reviews, top 10 principal medical diagnoses, beneficiary demographics, provider review settings, confirmed quality of care concerns, and Immediate Advocacy reviews and success stories.
1Data are from BFCC-QIO Annual Medical Services Reports for contract year 3 (8÷1÷16 – 7/31/17).