CMS will consolidate several Medicare quality reporting programs into a single contract worth up to $25 billion, the agency announced on May 15, 2018. The initiative is called the “Network of Quality Improvement and Innovation Contractors” (NQIICs), under which multiple organizations will be awarded Indefinite Delivery/Indefinite Quality contracts with a 10-year ordering period. The agency’s goal is to identify high-performing groups it can call on to craft solutions to care-and-quality problems occurring in various regions across the country, spanning the full healthcare spectrum.

The program will include efforts from Quality Innovation Networks-Quality Improvement Organizations (QIN-QIOs), End State Renal Disease Networks, Hospital Improvement Innovation Networks, clinician-focused technical assistance groups and other quality improvement organizations. The NQIICs will serve as quality improvement experts and facilitators for hospitals, clinicians and long-term care facilities to work together to reduce hospitalizations, readmissions and poor care outcomes. The target beneficiaries are Medicare patients requiring care across primary, acute and post-acute settings who may currently be at a disadvantage because their providers use multiple quality contractors. Under the new structure, NQIIC groups will attempt to coordinate the quality measures across multiple providers and care settings.

CMS is also aiming to reduce overwhelming quality reporting burdens on providers. CMS hopes that the NQIIC initiative will solve legitimate provider complaints surrounding too many measures and too many rules on how to meet those measures. CMS anticipates NQIICs will be “tight on ‘what’ outcomes and flexible on ‘how’ methods.”

The proposal is not without controversy. Hospitals may not be pleased with the new structure, as it may mean that QIN-QIOs will no longer have capacity to conduct claims audits due to their new duties under NQIICs. Hospitals may prefer QIN-QIO claims audits because they tend to be overseen by clinicians, as opposed to Recovery Audit Contractors who are paid a portion of each overpayment they find while combing through a provider’s records.

Applications for NQIICs will be accepted through June 26, 2018, and awarded December 1, 2018. Additional information can be found here.