Texas Organization Leads Medicare Quality Improvement Program
By Phil West

A Texas organization has secured a five-year contract to continue assisting physicians with Centers for Medicare & Medicaid Services (CMS) initiatives aiming to improve care for Medicare patients, including physicians enrolled in the Quality Payment Program.

TMF Health Quality Institute, an Austin-based organization founded in 1984 that has worked with CMS on previous quality of care initiatives, will oversee the newly formed Southcentral Quality Innovation Network-Quality Improvement Organization (QIN-QIO), comprising Texas and four neighboring states – Arkansas, Louisiana, New Mexico, and Oklahoma. TMF previously managed a QIN-QIO, which was active from 2019 to earlier this year, that included Texas, Arkansas, Mississippi, Nebraska, Puerto Rico, and the U.S. Virgin Islands.  

In the past, TMF has provided guidance for Merit-Based Incentive Payment System (MIPS) participants to improve their performance scores and plans similar guidance in this cycle – and its new slate of priorities align with several MIPS performance categories. 

In Texas, TMF is in the process of reaching out to more than 1,000 physician practices – about two-thirds of which are staffed by three or fewer practitioners – as well as health care centers that CMS has identified as prospective QIN-QIO participants.  

“I am so proud of the work that [TMF is] able to do to assist enhancing delivery of good quality health care for our Medicare population,” said E. Linda Villarreal, MD, past president of the Texas Medical Association and current member of TMF’s board of trustees. 

Dr. Villarreal adds that some physicians identified by CMS are chosen to share how they practice because they excel in metrics like short hospital stays and low readmission rates, while others have potential to improve on MIPS performance scores and other quality of care markers. 

How it works

According to Tom Manley, president and CEO of TMF, physicians and health care entities working with the initiative get free consulting and access to resources – including webinars, online training, and customized data dashboards and CMS-prepared reports – aiming to help them deliver care more cost-effectively and efficiently.  

Stating the initiative is “designed to improve health care quality, access, value and equity for people with Medicare,” CMS subsequently gets a return on its investment in TMF and other QIN-QIO program managers via Medicare savings.  

Eddie L. Patton Jr., MD, chair of TMA’s Council on Health Promotion and another TMF board member, said TMF’s expertise and experience helps physicians to reduce inefficiencies and improve care, especially thanks to the data the institute collects and shares with health care professionals.  

“There’s this fear about these quality improvement programs, that it is just more documentation and more stuff that [physicians] have to do,” he said. “Sometimes, you just don’t know what you can and can’t improve upon unless you see what’s happening outside of your practice and your community.”  

Project details 

Clinical targets for the Southcentral QIN-QIO for this five-year contract include:  

• Prevention and chronic disease management, encompassing vaccinations as well as care for type 2 diabetes, hypertension, and chronic kidney disease;  

• Patient safety, involving risk assessment and plan of care related to falls, as well as adverse drug events; 

• Behavioral health, including depression, suicide risk assessment, prevention of substance use disorders, and chronic pain management; and  

• Care coordination, focused on emergency department utilization and patient readmissions.  

“TMF has worked in all these areas before,” Mr. Manley said. “This work is not new to us, and that’s one of the benefits of us continuing to work in this region, that you’ve got our experience and our deep knowledge of health care in this region.”  

He adds that throughout TMF’s long history of working with physicians, TMA support has been instrumental – and in turn, the institute has frequently coordinated with the association, remaining an active sponsor of TMA, the TMA Foundation, and TMA’s annual TexMed conference. 

Sheila Magoon, MD, in her role as executive director for Buena Vida y Salud, a Harlingen-based accountable care organization (ACO), has collaborated with TMF since 2009 – first in a hospital-focused effort to reduce patient readmissions, and then in the previous iteration of the QIN-QIO that TMF managed.  

“They were able to come in and help educate our physicians,” Dr. Magoon said. “They were also very instrumental in helping our ACO set up a pilot for behavioral health integration.”  

TMA physicians who are not on TMF’s candidate list, yet are interested in taking part, may contact TMF via email for more information on the program.