Professional Documents
Culture Documents
Nwewsletter Spotlight Fall 2008
Nwewsletter Spotlight Fall 2008
ON
Fall 2008
Vol. 6 No. 4
www.ohiokepro.com
Quality
A n e w s l e t t e r a b o u t O h i o s h e a lt h c a r e q u a l i t y i m p r ov e m e n t
Opening Ceremony
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Opening Ceremony
Every four years, the world comes together to watch our
greatest athletes compete for Olympic gold and for the glory
of their country. It never ceases to amaze me. With all of the
conflict, poverty and problems of the world, how is the
International Olympic Committee able to bring these
countries together year after year? The committees Web site
says that it acts as a catalyst for collaboration between all
members of the Olympic family [to] shepherd success
through a wide range of programs and projects which bring
the Olympic values to life.
Full POtEntial
from page 3
Healthcare is becoming increasingly focused on
measurable results. Now more than ever,
consumers are able to choose healthcare
providers based on publicly reported
information about providers performance.
Your electronic health record is a time-saving
tool to proactively manage patient populations,
set improvement goals and improve the health
of your patients. With the right care management
functions in place, your practice can create
appropriate, measurable, and cost-effective
intervention programs using your electronic
health record. Are you using it to its fullest
potential?
Bonnie Hollopeter, LPN, CPHQ, CPEHR
Project Manager, bhollopeter@ohqio.sdps.org
Are you ready to move forward with your electronic health record?
Free consultation and technical assistance available through a new QIO project.
Does your physician practice meet the following criteria?
l I work at a solo or group primary care practice
l We will have an electronic health record implemented by October 31, 2008
l Our electronic health record is certified by the Certification Commission for
Healthcare Information Technology (CCHIT), which I have verified on the Web at
http://www.cchit.org/choose/ambulatory/2007/
l We would be willing to complete training and participate in a national project to
improve care management using electronic health records
l I can identify a leader and an identified physician champion within my practice that
would support this project
l We would be willing to report data on breast/colorectal cancer screenings and flu/
pneumonia immunizations to Ohio KePRO and the Centers for Medicare & Medicaid
Services (CMS)
If your physician practice meets these requirements, you are eligible to participate in a
two-year project to improve care management processes with the assistance of quality
improvement specialists from Ohio KePRO. The Prevention Project will focus on using your
existing CCHIT-certified electronic health record to improve rates of breast and colorectal
cancer screenings, as well as pneumococcal and influenza immunizations. Participants will
also learn new skills and techniques that can be applied to other quality measures.
Benefits of participation:
Free consultation on care management techniques, workflow and process redesign,
and electronic data reporting
Increase efficiency while improving patient care and health outcomes
Use your electronic health record proactively to manage patient populations and
evaluate your performance on key quality measures
For more information, call Bonnie Hollopeter at 1.800.385.5080 or e-mail her at
bhollopeter@ohqio.sdps.org.
REgulatORy
uPdaTe
Centralizing Medicare Claims:
The Transition from FIs to MACs by 2011
in an effort to reform the Medicare fee-for-services (FFS)
system and offer a centralized resource for all Part a and B
claims, Medicare is replacing the current fiscal intermediaries
(Fis) and carrier contracts with Medicare administrative
Contractors (MaCs) by 2011. in his 2005 report to Congress,
Michael leavitt, Secretary of health and human Services,
estimates that this transition could save the Medicare trust
fund a total of $900 million by the end of fiscal year 2010.
From page 5
Hospital Payment Monitoring Program Discontinues
Some Services, not All
In an effort to align the oversight of acute
inpatient prospective payment system (IPPS)
hospitals and long-term care hospitals (LTCHs),
some of the QIO responsibilities under the
Hospital Payment Monitoring Program (HPMP)
have transitioned to the fiscal intermediaries
(FIs)/Medicare Administrative Contractors
(MACs) or the Comprehensive Error Rate Testing
(CERT) contractors. Therefore, Medicare Fiscal
Intermediaries (FIs) and Medicare Administrative
Contractors (MACs) will now conduct medical
review to prevent improper payment of inpatient
hospital claims. Medical review is the process
performed by Medicare contractors to ensure
that billed items or services are covered and are
reasonable and necessary as specified under
section 1862(a)(1)(A) of the Act. In addition,
the Comprehensive Error Rate Testing (CERT)
contractor will now conduct medical review to
measure inpatient hospital payment error rates.
Also, QIOs will no longer provide Program for
Evaluating Payment Patterns Electronic Reports
(PEPPER).
Going Nowhere
with
Restraints
NEW ONLINE SELF-LEARNING MODULE
1 hour continuing education credits for nurses
Cost: Free
Upon successful completion of this online self-study module, participants will:
1. Describe the definition of a physical restraint, as used in nursing homes.
2. Discuss how and why restraints should be reduced or eliminated in nursing homes.
3. Identify at least five alternatives to physical restraints.
4. Discuss the legal requirements of restraint use in nursing homes.
Who should take this course?
Nursing home professionals, including administrators/CEOs, nurses, social workers, and QI
personnel
MRSa SuPERBug
The proportion of infections that are
antimicrobial resistant has grown
exponentially over the last 30 years,
according to a 2007 report by the Centers
for Disease Control and Prevention
(CDC). As illustrated in Figure 1,
Methicillin-resistant Staphylococcus
aureus (MRSA) infections accounted
for two percent of the total number of
staph infections in 1974. By 1995, that
number had grown to 22 percent. And in
2004, 63 percent of infections were
antimicrobial resistant.
First Steps
Forming a multidisciplinary team to develop a pressure ulcer
prevention program is an easy way to ensure long-term organizational
commitment to preventing pressure ulcers. IHI makes the following
recommendations:
Who to include on the team
Nursing (licensed nurses, assistants, technicians)
Education
Performance improvement
Dietary
Materials management staff
Senior leader
Patient or family member
Initial team responsibilities
Review current processes
Set aims
Lead the design and implementation of processes on a pilot unit
or area
References
CASPER Report 0314S, Most Frequently Cited Tags, Chicago
Regional Office, Ohio, 05/16/2008.
Duncan, K., Preventing Pressure Ulcers: The Goal Is Zero. The
Nursing Home
More than 108,000 nursing home residents are physically restrained in the
United States every day.1 Research and standards of practice show that the
belief that restraints ensure safety is often unfounded. In practice, restraints
have many negative side effects and risks that in some cases far outweigh
any possible benefit that can be derived from their use.2 In fact, as many as
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S pot l ight o n Qu a l i t y Fa l l 2 0 0 8
Medicare to Refuse
Payment for Preventable
Occurrences in October with
More to Follow
Beginning in October 2008, the Centers for Medicare & Medicaid Services
(CMS) will refuse hospital reimbursement for additional costs associated
with eight conditions or events, unless they were present on admission,
including:
1. Object left in surgery
2. Air embolism
3. Blood incompatibility
4. Catheter-associated urinary tract infections
5. Pressure ulcers (decubitus ulcers)
6. Vascular catheter-associated infection
7. Surgical site infection mediastinitis after
coronary artery bypass graft surgery
8. Hospital-acquired injuries fractures,
dislocations, intracranial injury, crushing
injury, burns, and other causes.
These serious preventable events or never
events are derived from the National Quality
Forums (NQF) list of 28 inexcusable outcomes in
a healthcare setting. The NQF defines never
events as serious, largely preventable, and of
concern to both the public and healthcare
providers for the purpose of public
accountability.
This change in Medicare reimbursement was
initiated in an October 2007 revision of the
Deficit Reduction Act of 2005.
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from page 13
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S pot l ight o n Qu a l i t y Fa l l 2 0 0 8
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Tear this calendar out and post it as a reminder of upcoming deadlines and events.
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Hospitals
Has your hospital experienced a change in the following personnel: CEO, QI contact, medical records
contact, or QNet security administrator? If so, please contact Fran Hober at fhober@ohqio.sdps.org or
216.447.9607 Ext. 2115. Fran is your contact for important CMS public reporting program changes and
deadlines.
Attention hospital QI contacts: You will continue to receive quality measure comparative graphs or
leadership graphs in your QualityNet inbox within 15 days after the quarterly data submission deadline.
Expect an e-mail notification around the first of December with instructions for accessing your new report.
Sign your Memorandum of Agreement (MOA) and return it to Ohio KePRO by October 31, 2008. All
Medicare-certified facilities are required to sign an MOA with Ohio KePRO every three years, at the beginning
of each new QIO contract period. In October, your CEO/Administrator will receive two copies of the new MOA
and a provider update form. Please complete these documents and return them immediately as instructed.
Contact Liz Paduano at 216.447.9604 Ext. 2222 with any questions.
Reminders
CDAC requests for charts from second quarter 2008 will be sent at the
beginning of this month. Charts must be sent within 30 days of request.
December
October 31, 2008 Deadline for signing and returning the MOA.
October 21, 2008 Quality Week Webcast: Using Data to Drive Patient
Safety Healthcare. Approved for 1.5 CPHQ CE credits and 1.5 contact
hours CPHRM renewal. For more information or to register, visit
http://www.nahq.org/hqw/.
H
ospitals or vendors to submit second quarter 2008 outpatient
quality measure data to the clinical data warehouse.
November 1, 2008
Hospitals or vendors to submit second quarter 2008 ICD population
and sampling counts for the inpatient quality measures to the
clinical data warehouse.
October 8, 2008 Submit June 2008 dry run data and second quarter
2008 HCAHPS Survey Data to the Clinical Data Warehouse.
November
October
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Reporting Hospital Quality Date for Annual Payment Update (RHQDAPU) Program Calendar 4Q08 reporting deadlines:
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S pot l ight o n Qu a l i t y Fa l l 2 0 0 8
A 2001 study using the Beers criteria in a Medicaremanaged care population found that 23 percent of patients
in the study were prescribed potentially inappropriate
medications. Post this reference chart as a reminder of
medications that may be unsuitable for your older patients.
Fick, D., Cooper, J., et al. Updating the Beers Criteria for
Potentially Inappropriate Medication Use in Older
Patients. Arch Intern Med. 2003;163:2716-2724
Safe Prescribing in the Oklahoma Elderly (SPOKE).
http://www.ofmq.com/spoke1 <http://www.ofmq.com/
spoke1> , last accessed 8/28/08.
Sources:
Elderly Patients
At A Glance
Notices of non-coverage are now given routinely in all inpatient and some outpatient
settings. A list of these notices follows:
Notice
Who?
When?
Notes
Important Message
Hospitals including
No greater than
from Medicare
long-term acute care
two days prior to
discharge
Regardless if patient is
enrolled in a Medicare
traditional fee for
service or Medicare
Advantage plan
Detailed notice
All
For Medicare
Advantage, the plan
generally makes the
decision, but it is the
facilitys or agencys
responsibility to deliver
the notices
When an appeal
is requested
The updated Fee-for-Service Expedited Review Notice (the Generic Notice), Form No. CMS-10123 (Expiration date: 07/31/2011) and the Detailed Notice, Form No.
CMS-10124 (Expiration date: 07/31/2011), are now available on the BNI webpage at http://www.cms.hhs.gov/BNI/. CMS is allowing a 60-day transition period for
mandatory use of the updated forms. Mandatory use of the updated forms will begin on November 1, 2008.
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TeLL uS
SPOTLIGHT
oN
Fall 2008
Vol. 6 No. 4
www.ohiokepro.com
Quality
a N e w s l e t t e r a b o u t o h i o s h e a lt h c a r e q u a l i t y i m p r o V e m e N t
OPenInG CeremOny
TaPPInG InTO yOur eLeCTrOnIC HeaLTH
reCOrdS FuLL POTenTIaL
reGuLaTOry uPdaTe
GOInG nOwHere wITH reSTraInTS
Ten wayS TO BeaT THe mrSa SuPerBuG
PrevenTInG PreSSure uLCerS In THe
aCuTe Care SeTTInG
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