About Medicare
By
federal law, Medicare+Choice (M+C) organizations must meet quality assurance
and performance improvement (QAPI) requirements. By 2001, organizations
are required to achieve compliance through the use of the Center for Medicare
and Medicaid Services (CMS, formally known as HCFA) Quality Improvement System for Managed
Care, known as "QISMC." QISMC is also a tool that States may
use to ensure that Medicaid plans meet comparable quality assurance obligations.
The first product of the QISMC initiative is a set of quality assurance
standards and clarifying guidelines. These standards direct an M+C organization
to:
Operate an internal program of quality assessment and performance improvement that achieves demonstrable
improvements in enrollee health, functional status, and satisfaction across a broad spectrum of care and services. M+C organizations have considerable discretion to select focus areas addressing specific health care and service needs of their populations.
Collect and report data reflecting performance on standardized measures of health outcomes and enrollee satisfaction, and meet such minimum performance levels on these measures as may be established under its contract with CMS or states.Demonstrate compliance with basic requirements for administrative structures and processes that promote quality of care and beneficiary protection.
RESOURCES
Our Services
Syntro offers a menu of services and tools, which are adapted to fit
your needs. After understanding your objectives and internal resources,
we assess your organization's needs and help you determine areas currently
in compliance, as well as gaps with each standard requirement.
The Assessment
Your assessment includes reviewing key plan documents, evaluating core
processes, auditing files and interviewing staff responsible for managing
and implementing standards. We complete the initial assessment using
the version of the QAPI guidelines and applicable materials.
If desired, you may request an assessment against multiple sets of standards, for example, Medicare and Medicaid regulations, JCAHO and URAC.
Establish Priorities
The assessment results help you establish priorities and determine areas
needing the highest degree of focus. You receive from us an action plan
for the gaps, written in a project-plan format that you can use for
management. We help you work through the variables necessary in setting
the priorities that are right for your organization.
Develop a Plan
Your action plan serves as the basis for developing a full plan for
implementation of the standards and/or survey preparation. The plan
is a living document that you update and modify.
Tools and Templates
You may desire other resources that make implementation and survey preparation
easy and minimize struggle and stress. Our tools library
(click here
to review) provides tools to help guide implementation as well as sample
program documents, and policy and procedure templates. We have done
the research, analysis, and organized all information into easy-to-use
guidelines and templates, saving you many hours of time and money. These
tools are based on years of experience in the field and as surveyors.
Other Services
We tailor our services to match the needs and desires of the organization.
Services can range from an initial evaluation and report, to quarterly
site visits with intermittent conference calls and off-site document
review, to onsite project management. (click here to access information
on Syntro consulting services).
