QIPMO faces an uncertain future and during our visit Dr. Rantz had voiced serious concerns about the program's chances for survival. The transition of the survey agency into the Department of Health with the resulting loss in staff that had previously supported the program coupled with the QIO initiative has created an uncertain situation. Rantz stated that it had been difficult to keep the funding this year as the new survey agency staff needed to be convinced that funding for QIPMO was preferable to hiring more surveyors. She was able to demonstrate some of the good outcomes associated with QIPMO and by working with a few supportive legislators, was able to save the program this year.
The new QIO initiative is similar to QIPMO in that it also involves the provision of technical assistance to nursing facilities targeting certain quality indicators for improvement. As the QIO effort got underway, there was concern that the state would see the two programs as duplicative and decide not to continue funding QIPMO. At the time of our visit, the Missouri QIO with whom we had met several times was eager to work with QIPMO and design their programs to complement, not duplicate QIPMO. But, an obvious question that arose was if the state can get the Federal Government to pay for its quality improvement program through the QIO, why then should they also pay for QIPMO? Dr. Rantz stated almost regretfully that she had "helped light the fire" of the QIO program by demonstrating that facility outcomes can be improved through on-site visits and at a relatively small cost.
In a follow-up conversation with Dr. Rantz in November 2002, she indicated that a subcontract for QIPMO nurses to do on-site visits and provide technical assistance to nursing facilities within the QIO scope of work had been successfully negotiated with the QIO and approved by CMS. Dr. Rantz is pleased to collaborate with the QIO as it appears that the QIO work will enhance and not duplicate QIPMO work with facilities.
Marilyn Rantz pointed out that for a program to demonstrate effectiveness, it must be data driven. Data must be presented in a format that is understandable to facility staff and education must be provided around the concept of quality and goal setting. Facilities are too often satisfied with just average performance. Data must assist users to identify the specific residents involved and show changes over time.