Healthcare Quality Strategies, Inc., (HQSI) is the Medicare Quality Improvement Organization (QIO) for New Jersey. In our role as the QIO, we are implementing the Centers for Medicare & Medicaid Services’ (CMS’) Ninth Scope of Work (9th SOW) for the Medicare program, which involves multiple provider types in a three-year initiative encompassing the following themes:

Under this theme, HQSI reviews Medicare patients’ medical records to ensure care rendered is medically necessary, provided in the appropriate setting, and of a quality that meets accepted professional standards. HQSI also works with providers to develop, implement, and evaluate quality improvement plans to address confirmed quality concerns.

The patient safety theme is designed to focus on areas where evidence demonstrates that improved processes and systems can reduce patient harm. Our quality improvement activities focus on:

Building upon the success of the Eighth Scope of Work (8th SOW) Doctor’s Office Quality – Information Technology (DOQ-IT) initiative, the 9th SOW prevention theme focuses on improving the quality and frequency of preventive healthcare services that Medicare beneficiaries receive by supporting physician office practices in the continued use of their electronic health record (EHR) systems. HQSI is assisting primary care practices to increase practice efficiencies while improving patient care and health outcomes through: 

The care transitions theme focuses on improving the coordination of care as patients move between care settings to reduce unnecessary or preventable re-hospitalizations. HQSI is one of only 14 QIOs selected by CMS to conduct a project in this area. We are facilitating an initiative with a group of hospitals, nursing homes, home health agencies, physician offices, community-based organizations, and healthcare stakeholders in southwestern New Jersey that is designed to promote smooth care transitions across provider settings. Interventions will address issues related to medication management and reconciliation, care planning, and care coordination. This initiative targets specific conditions associated with preventable hospitalization and promotes the use of patient health records and increased patient self-management. The following table provides a summary of activities by provider setting and 9th SOW theme and topic.

*Medicare-certified providers of all types are impacted by Medicare Case Review (Beneficiary Protection Theme). Click on Medicare Case Review to learn more.