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2011 TMF Membership Update

This update reflects the status of TMF activities as of the time it was written (June 2011).

June 2011

TMF Health Quality Institute focuses on improving lives by improving the quality of health care through contracts with federal, state and local governments, as well as private organizations. For over 40 years, TMF has helped health care providers and practitioners in a variety of settings improve care for their patients. This update (195kbs PDF) provides highlights of our current contracts.

Quality Improvement Organization (QIO) for Texas
Current contract (2008 − 2011) projects focus on supporting Medicare beneficiaries, promoting patient safety, encouraging preventive health care services and reducing hospital readmission rates by improving care transitions. For less than 33 cents per beneficiary per month, TMF’s activities improve the quality of health care for more than 2.9 million Texas Medicare beneficiaries.

The Medicare QIO program is administered by the Centers for Medicare & Medicaid Services.

Beneficiary Protection
A key responsibility of the QIO program is to protect the rights of Medicare patients and evaluate quality of care provided through medical record review. Under the current three-year contract, TMF continues to carry out statutorily mandated review activities:

Reviewing the quality of care provided to beneficiaries
Reviewing beneficiary appeals of certain provider notices
Reviewing potential Emergency Medical Treatment and Active Labor Act (EMTALA) violations (anti-dumping cases)

TMF is increasing efforts to link case review activities to improvements in the delivery of care by developing quality improvement activities focused on system-wide changes. TMF uses data from case review activities to identify problems related to the quality of care and design quality improvement activities to help correct these problems.

Patient Safety
In the current statement of work, our focus on patient safety has been expanded, and TMF is working with providers to implement more programs to improve safety by combating growing issues like infection and drug safety. TMF’s patient safety activities focus on six primary topics:

Reducing rates of health care-associated methicillin-resistant Staphylococcus aureus (MRSA) infections
Reducing rates of pressure ulcers in nursing homes and hospitals
Reducing rates of use of physical restraints in nursing homes
Improving inpatient surgical safety and heart failure treatment in hospitals
Improving drug safety
Providing quality improvement technical assistance to nursing homes in need

Prevention
TMF is continuing to work with physicians, helping them maximize the use of their electronic health records, with a focus on improving the quality and frequency of preventive health care services to optimize beneficiary quality of life and health care efficiencies. Collaborating practices work with TMF to implement care management processes using their certified EHRs. TMF’s goal is to improve the rates of:

Mammography screening
Colorectal cancer screening
Influenza immunization
Pneumococcal immunization

Additionally, TMF is working on a chronic kidney disease (CKD) program, focused on educating at-risk patients and promoting timely screenings and preventive measures. A key component of TMF’s CKD quality improvement effort is coalition building and collaboration with providers in the state as well as other partners that can support CKD efforts at the local, state and national levels.

Care Transitions
TMF is one of 14 QIOs in the country selected to improve coordination of care across clinical settings. The primary goals of this effort are to:

Reduce hospital readmission rates
Improve coordination of care across the continuum of health care settings
Reduce the high costs of care associated with avoidable inpatient hospital stays

TMF is conducting a project in the Lower Rio Grande Valley to measurably enhance the quality of care for beneficiaries by assisting providers in improving medication management, post-discharge follow-up, communication and coordination of care.

Vaccines for Children
TMF provides assessment and education of Vaccines for Children providers in Texas, Delaware, Arizona, Kansas and Kentucky. These programs are funded through grants from the Centers for Disease Control and Prevention to state health departments. TMF conducts individual physician office assessments and assists with quality improvement activities aimed at increasing immunization rates for children. Since 2001, TMF has conducted more than 26,000 site visits.

Medicaid Surveillance and Utilization Review
TMF has been working to expand our role with the state of Texas and has had significant success as a sub-contractor to Affiliated Computer Services (ACS) conducting Medicaid surveillance and utilization review. TMF reviews statistical profiles of health care delivery utilization patterns for Texas Medicaid physicians and other health care providers and identifies quality of care issues and potential fraud, abuse and waste. TMF performs retrospective medical record and prepayment reviews.

Since initiating this relationship in 2008, TMF has exceeded expectations, resulting in an expansion of the contract and we are currently in talks to take on additional contract responsibilities as well. In addition, we continue to seek opportunities to be involved in Medicaid quality improvement activities.

Reducing Health Disparities in Diabetes Care
TMF is one of only two QIOs chosen by CMS to implement a disparities-driven diabetes quality improvement special project. This community-based initiative focuses on improving treatment and self-management of diabetes among Hispanics and American Indians in five Texas counties, as well as selected metro areas. We are conducting a parallel project focusing on Medicaid and non-Medicare beneficiaries, funded by CMS and the National Institutes for Health.

Regional Extension Centers
TMF supports the North Texas, Gulf Coast and West Texas Regional Extension Centers in assisting physicians and other health care professionals with selecting and implementing electronic health record systems and using them in a manner to become eligible for federal incentive payments. Through outreach, education and assistance, the centers help providers use HIT to improve quality of care. TMF’s role is to offer providers on-site technical assistance, guidance and information on best practices.

PEPPER and FATHOM
In 2009, TMF won the contract to provide inpatient hospital outlier monitoring and hospital-specific reporting for all Medicare acute care hospitals throughout the country. To help prevent inappropriate Medicare payments, TMF provides hospital-specific Program for Evaluating Payment Patterns Electronic Reports (PEPPERs) to CMS and each acute care hospital in the nation to facilitate proactive monitoring. Through this contract, TMF also provides the national First-look Analysis Tool for Hospital Outlier Monitoring (FATHOM) to CMS and jurisdiction-specific FATHOMs to Medicare Administrative Contractors and Fiscal Intermediaries to assist with data analysis and targeted sampling of medical records from providers.

TMF’s demonstrated abilities and strong contract performance led CMS to expand TMF’s responsibilities and the services offered under this contract. In 2010, TMF was awarded a contract to provide PEPPER to three additional hospital settings: critical access hospitals, inpatient psychiatric facilities and inpatient rehabilitation facilities nationwide.

Indigent Care Services
TMF provides ongoing assessment and analysis of the utilization and quality of health care services provided to indigent clients for county hospital districts. Currently TMF holds contracts with the Nueces and Montgomery County Hospital Districts and Williamson County and Cities Health District. We are currently negotiating an expansion of our contract with Williamson County and are looking for opportunities to assist other counties with their indigent programs.

HIV Health Services
The quality assurance review of HIV health services offers another area for application of TMF’s quality improvement expertise. TMF conducts these review services through contracts with Dallas County Health and Human Services every two years since 2004, Harris County Public Health and Environmental Services annually since 2007 and as of 2010, the City of Austin. TMF evaluates Funded Primary Medical Care Services available through the Ryan White Title 1 Grant with the goal of ensuring the best care possible for those affected by HIV.

Agency for Healthcare Research and Quality (AHRQ)
As a subcontractor to the American Institutes for Research, TMF continues to perform the Standardizing Antibiotic Use in Long-term Care Settings (SAUL) study. The project assesses current antibiotic utilization practices in a group of long-term care facilities and develops new approaches to optimizing antibiotic prescribing practices in a subset of facilities. In 2010, TMF began serving as a subcontractor to Texas A&M Health Science Center on a study to prevent Clostridium difficile infection (CDI) in nursing homes. Funded by AHRQ, the project implements the use of a CDI control bundle in the nursing home; enhances communication among providers as individuals transition between nursing homes and hospitals; determines costs and potential savings of the intervention; and determines the extent to which nursing homes and hospitals serve as a source of CDI among individuals transferred between care types.

Texas Department of State Health Services
In 2010, as a subcontractor to Texas Hospital Association, TMF was awarded a contract to help develop and implement interventions to prevent surgical site infections in Texas hospitals. TMF’s role includes identifying and recruiting hospitals; developing interventions, tools and education; administering the AHRQ survey on Patient Safety Culture to participating staff; and collecting, analyzing and reporting intervention data.