Success Stories

Quality Improvement Organization Accomplishments (2005 – 2008)

Nursing Home Quality Improvement

For less than 33 cents per beneficiary per month, TMF’s activities improve the quality of health care for more than 2.9 million Medicare beneficiaries

TMF worked intensively with 170 nursing homes in Texas to improve the quality of care provided to residents. Proportions of residents suffering from pressure ulcers, residents who were physically restrained, residents in chronic pain and residents suffering from depression all decreased.

We estimate that the lives of hundreds of nursing home residents living in nursing homes working with TMF were improved during this time period.1

• 195 fewer high-risk residents developed a pressure ulcer.
• 607 fewer residents were physically restrained.
• 62 residents had less pain.
• 160 fewer residents suffered from depression.

Home Health Agency Quality Improvement

TMF worked with 214 home health agencies in Texas to improve the quality of care received and to help patients become more independent.1

• 70 percent of these home health agencies showed an improvement in their acute care hospitalization rate between January 2005 and August 2007.
• 36 percent of the improved facilities continued to show improvement after the end of the project.

Hospital Quality Improvement

TMF worked intensively with 64 hospitals in Texas to improve the quality of care received by patients. The proportion of patients receiving appropriate care for heart failure, acute myocardial infarction and pneumonia all increased.

We estimate that the lives of hundreds of patients admitted to hospitals working with TMF were improved during this time period. 1

• 633 more patients received appropriate care for heart failure.
• 243 more patients received appropriate care for AMI.
• 1,193 more patients received appropriate care for pneumonia.

TMF worked intensively with another 32 hospitals on the Surgical Care Improvement Project. This group achieved a 44 percent improvement over two years in the average scores for the designated quality measures.

Physician Practice Quality Improvement

TMF recruited 300 practices (1,000 physicians) to receive support with the adoption and/or best use of an electronic health record.

• Of the practices that signed a contract for an EHR by the end of this program, 69 percent had implemented the EHR.
• Of the practices that implemented an EHR, 92 percent were using basic features such as medication management, problem lists and lab results, while 59 percent were using care management features.

Beneficiary Complaint Response

TMF completed 618 Medicare beneficiary complaint reviews during the 2005 – 2008 contract period.

• 141 of these cases had at least one confirmed quality of care issue.
• As a result of these cases, providers or practitioners initiated 168 quality improvement activities.
• 38 cases were addressed through mediation, in which the two sides of a conflict are guided to a resolution by an impartial third party in a face-to-face, confidential meeting.

Hospital Payment Monitoring

TMF conducted routine and special study activities to ensure Medicare trust fund dollars were spent appropriately.

• TMF’s monitoring of the surveillance system sample of approximately 300 inpatient hospitals recouped over $907,754 from inappropriately billed claims.
• Through a special project, TMF decreased one-day stays 19 percent in a group of 18 hospitals. Savings of approximately $7 million were estimated as a result of working with these hospitals to improve their billing practices and reduce inappropriate admissions. The project’s return on investment was $14.50 for each $1 spent.

1. Health care providers working with TMF received intensive support in the form of technical assistance and committed in writing to participate in quality improvement activities; providers statewide also received assistance but with less concentrated attention. Other factors may have contributed to this improvement, including collaborations at the statewide level among health care providers and partners.TMF performed this work as the Medicare Quality Improvement Organization for Texas, under contract with the Centers for Medicare & Medicaid Services, an agency of the U.S. Department of Health and Human Services. For data source(s) and methodology(ies) for data presented, please contact TMF.