The Centers for Medicare & Medicaid Services (CMS) has contracted with Healthcare Quality Strategies, Inc., (HQSI) to serve as the Medicare Quality Improvement Organization (QIO) for New Jersey since the inception of the Quality Improvement Program and the Medicare Peer Review Program (a precursor to the current QIO program) in 1984. CMS’ three-year contracts are referred to as Scopes of Work (SOWs). As a QIO, we work closely with healthcare providers across all settings of care, consumers, and stakeholders to improve the quality of care provided to 1.3 million New Jersey residents with Medicare.

The Medicare QIO program is dedicated to ensuring that patients get the right care at the right time. Its mission is to improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries. HQSI’s current contract with CMS, which is known as the Ninth Scope of Work (9th SOW), focuses on beneficiary protection (Medicare Case Review), patient safety, prevention, and care transitions. 

HQSI has made a measurable difference in the quality of care in New Jersey through our work as a QIO. HQSI achieves improvements by assessing current practices, identifying opportunities to improve care, promoting best practices, measuring and tracking improvement, and assisting with healthcare technology adoption and use. We provide free education, tools, and materials to assist providers in accelerating healthcare quality improvement. In addition, HQSI reviews Medicare patients’ medical records to ensure the care rendered is medically necessary, provided in the appropriate setting, and of a quality that meets accepted professional standards. We also promote and support Medicare patients’ rights.