Project Overview (Medicare)

Since 1984, MPRO has served as the federally designated quality improvement organization (QIO) for the state of Michigan. Every state and U.S. territory has a QIO. QIOs, like MPRO, are under contract with the Centers for Medicare & Medicaid Services (CMS). CMS has identified the following requirements for the QIO Program:

• Improve the quality of care for beneficiaries (there are approximately 1.5 million Medicare beneficiaries in Michigan);

• Protect the integrity of the Medicare Trust Fund by ensuring that Medicare pays only for services and goods that are reasonable and
medically necessary and are provided in the most appropriate setting; and

• Protect beneficiaries by expeditiously addressing individual complaints, such as beneficiary complaints; provider-based notice appeals;
and other related statutory QIO responsibilities.

MPRO works with CMS in three-year contract cycles known as Scopes of Work. Our current 9th Scope of Work (9SOW) began on August 1, 2008 and will conclude on July 31, 2011. In the 9SOW, MPRO assists Michigan Medicare providers (free of charge) to improve the quality and delivery of health care by embracing evidence-based medicine to improve processes and outcomes. Interventions include the following:

• Beneficiary Protection
• Patient Safety
• Prevention