Case Study

What We Did

• • As part of the Oversight of State Performance Contract, HMS provided a highly specialized Quality Monitor to conduct on-site observations and independent evaluation of the progress of IHS hospitals in meeting the terms of their Systems Improvement Agreements (SIAs).
  • The Quality Monitor provided written reports to CMS, which included:
    • Observations, interviews, and record reviews that were conducted, and any patient safety or quality concerns identified;
    • Any complaints received by the Monitor;
    • Assessment of adequacy of hospital staffing;
    • Information regarding progress or lack
      thereof made on each IHS obligation under the SIA, including the action plans described in the SIA, and;
    • Any other issues or concerns that arose during the SIA period.
  • The Quality Monitor also arranged and conducted quarterly comprehensive reviews of each hospital’s progress with respect to the terms of the SIA and provided the results to CMS in a quarterly teleconference.
  • The Quality Monitor worked directly with the hospitals’ management teams, the Emergency Services teams, and other hospital staff and communicated directly with CMS and other parties engaged by the hospitals to oversee implementation of the SIA.
  • This project encompassed a review of hospital operations at all levels from governing body through direct patient care and discharge, and required a robust review of hospital staffing, policies and procedures, outcomes, and more.

Background

• • The SIA is a legal contract between a healthcare facility and CMS to aid compliance with the Conditions of Participation (CoPs) in federal programs.
  • Due to significant access to care issues that exist on many Indian reservations, CMS exhausted every avenue possible to support the assigned hospital in reaching and maintaining compliance.

HMS Demonstrated Value

• • HMS was able to respond quickly to this request for a highly specialized Quality Monitor.
  • The Quality Monitor had to be capable of identifying and monitoring issues across all of the hospital conditions of participation.
  • Additionally, they had to have a firm understanding of the cultural sensitivities of the local Indian reservation community and have demonstrated experience in improvement of hospital quality of care and patient safety.

Agencies Involved

• • Centers for Medicare and Medicaid Services (CMS): CMS combines the oversight of the Medicare program, the federal portion of the Medicaid program and State Children’s Health Insurance Program, the Health Insurance Marketplace, and related quality assurance activities.
  • Indian Health Services (IHS): An agency within the Department of Health and Human Services, IHS is responsible for providing a comprehensive health service delivery system for American Indians and Alaska Natives, in order to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level.