User:AFMCwebteam/Arkansas Foundation for Medical Care

Arkansas Foundation for Medical Care, Inc. (AFMC) is a nonprofit corporation dedicated to improving the quality of health care for Arkansans. It is the Medicare [Quality Improvement Organizations] (QIO) for Arkansas, federally contracted through Centers for Medicare & Medicaid Services and also contracts with State Department of Human Services, divison of Medical Services to review and improve care for Arkansas Medicaid beneficiaries.

Historical Perspective In 1972, Congress authorized the formation of Professional Standards Review Organizations (PSROs) to monitor the appropriateness, quality, and outcome of the services provided to beneficiaries of the Medicare, Medicaid, and Maternal and Child Health programs. At the time, Arkansas’ leading physician organization, the Arkansas Medical Society (AMS), responded to this legislation with the formation of an independent board committee to monitor utilization efficiency in the state’s hospitals. As the committee’s work grew in time and intensity, it was decided to form a separate organization. In late 1972, it became known that the Medical Society could not qualify as a PSRO. Therefore, a separate entity was formed: the Arkansas Foundation for Medical Care, Inc. (AFMC). In 1973 the first governing board was elected. With a $500 loan from the Arkansas Medical Society, the board applied to the Department of Health, Education and Welfare (DHEW) to become the Professional Standards Review Organization for Arkansas.

The original by-laws limited AFMC’s membership to individuals who were also members of AMS. The original board of directors was the Council of the Society (AMS’ board of directors). Similarly, the first AFMC officers were those holding similar positions at AMS. However, the law required that membership in another organization could not be a requirement of membership in the PSRO and that the governing board had to be separate from any other organization.

With the enactment of the Tax Equity and Fiscal Responsibility Act(TEFRA)legislation and the Social Security Amendment of 1983, the concept of medical peer review was expanded. The scope of the Prospective Payment System radically changed the way hospitals were reimbursed by introducing the DRG (Diagnosis Related Group) payment system, and PSROs became Peer Review Organizations (PROs). PROs were now interested not in length of stay, but in the medical necessity and appropriateness of hospital admissions, which triggered the DRG payment. AFMC became a single, statewide organization employing safeguards to prevent conflict of interest reviews and, with the aid of federal legislation, enacted protections for the confidentiality of the identity of physician reviewers. In 1986, AFMC was the first PRO in the nation to sign for extension of the two-year cycle of review.

In response to a 1992 Institute of Medicine report that linked individual instances of poor health delivery to indicators of quality in the larger system of care, the Health Care Financing Administration, or HCFA (the predecessor of the Centers for Medicare and Medicaid Services), directed PROs to expand their role by implementing systems-based quality improvement initiatives by working directly with providers and educating beneficiaries. To formalize this role, CMS launched the Health Care Quality Improvement Program (HCQIP) in the mid-1990s. AFMC changed its designation from a PRO to a Quality Improvement Organization (QIO) in 2002. QIOs compete for three-year contracts from CMS. These contracts are known as statements or scopes of work (SOW). Currently, AFMC is operating under the 9th SOW. A comprehensive background of SOWs 1-9 follows this historical perspective.

As the health care needs of Americans continue to evolve, so too does the work of AFMC. The organization has changed a great deal in the past three decades. In 1993 a second office was established in Little Rock to increase AFMC’s presence in the state’s capital. Medicaid Managed Care Services (MMCS), the first of AFMC’s programs headquartered in Little Rock, and others that followed, significantly increased the organization’s central Arkansas presence. Today, AFMC has a staff of more than 154 professionals that includes specialists in clinical medicine, data management, epidemiology and statistics, quality improvement, and communications. The overall organizational responsibilities continue to evolve. Short-term objectives may change, but the core mission — "promoting excellence in health care through evaluation and education" — remains unchanged.