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 ov e m e n t

Opening Ceremony

Ten Ways to Beat the MRSA Superbug

3
5
6
7

Preventing Pressure Ulcers in the

Acute Care Setting

Tapping into your Electronic Health

Records Full Potential
Regulatory Update
Going Nowhere with Restraints

Reconsidering Physical Restraint Use

in the Nursing Home

10

Medicare to Refuse Payment for Preventable

Occurrences in October with More to Follow

Drugs to Avoid with Elderly Patients

11
13
14

Required Medicare Notices of

Non-Coverage At A Glance

15

Calendar/Reminders

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.

Like the International Olympic Committee,

Ohio KePRO is also a catalyst for collaboration.
As the Medicare Quality Improvement
Organization (QIO) for Ohio, we bring Ohio
healthcare providers together in collaborative
projects to share successes and best practices.
Weve found that creating a learning, sharing
community is the best way to help providers
achieve their goals.

Last month, around the same time as the 2008

Olympic opening ceremonies, the QIO program
embarked on a new three-year contract with the
Centers for Medicare & Medicaid Services
(CMS). As a result, some of Ohio KePROs
services for healthcare providers have changed.
The 2008-2011 QIO contract offers new
opportunities for healthcare providers to
participate in quality improvement activities in
key areas, such as patient safety, prevention

2 Spo t l ight o n Q u al i t y Fal l 2 0 0 8

and Medicare beneficiary protection. By and

large, QIO program resources are concentrated
on helping providers that demonstrate the
greatest need and/or with the greatest
opportunity for improvement on specific quality
measures. To read more about the new QIO
contract, go to www.cms.hhs.gov/
QualityImprovementOrgs.
With this first edition of Spotlight on Quality,
we introduce key issues that will be the focus of
the CMS QIO program for the next three years.
This newsletter is designed to be a quarterly
resource for Ohio healthcare providers for best
practices in healthcare, quality tools, tips from
industry experts, key dates calendar, and
updates on CMS regulations. Enjoy!
Gayle Smith, RN, MBA
Vice President of Public Programs, Ohio KePRO

tappiNg iNto your electroNic health records

Full POtEntial

an electronic health record is a substantial investment. in addition to monetary costs, an

electronic health record system requires that all employees learn how to do their job differently.
its a change and change is always scary. So once your practice has implemented an
electronic health record and gotten most of the bugs out of the system and processes its time
to make sure that your practice is making the most of its investment.
Eighty-five percent of physicians with a
comprehensive electronic health record system
reported a positive effect on the delivery of
long-term and preventive care that meets
guidelines, according to an article published in
the July 2008 New England Journal of
Medicine. however in the same study, only
about half of respondents with a basic system
noted the same positive effect. is it the
comprehensive system that enables these
practices to deliver better care? Or could it be
that practices that implemented a comprehensive
system use it for more than just documentation?

as illustrated in the figure below, it is

undeniable that most respondents felt that their
electronic system helped them perform
essential job functions better.
Rates of Positive Survey Responses on the Effect of Adoption of
Electronic-Health-Records Systems

coNtiNued oN Next page

a nEWSl E t t ER a BOut h Ea lt h Ca R E Qua lit y iM PRO vE ME n t

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.

Source: NEJM. DesRoches et al. 359

(1): 50, Figure 1, July 3, 2008. http://
content.nejm.org/cgi/content/
full/359/1/50/F1, last accessed
8/29/08.
Note: Offices with a fully functional
system include four minimum features:
computerized orders for prescriptions,
computerized orders for tests, test
results (lab or imaging), and clinical
notes.

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.

Spot l ight o n Q u al i t y Fal l 2 0 0 8

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.

Detecting Improper Payments:

Implementation of RAC Program by 2010
By 2010, the Centers for Medicare & Medicaid Services plans
to have four Recovery audit Contractors (RaCs) in place to
ensure correct payments are being made to providers and
suppliers and, therefore, protect the Medicare trust Fund.
this decisions was made after a three-year RaC
demonstration projects in new york, Massachusetts, Florida,
South Carolina, and California ended in March 2008.

CMS designed 15 new MaC jurisdictions to balance the

number of fee-for-service beneficiaries and providers and to
be more alike in size than the existing Fi jurisdictions,
promoting greater efficiency in processing Medicares billion
claims a year. to date, CMS has awarded nine out of 15 total
MaC contracts. Ohio, which is in jurisdiction 15, is still
awaiting the announcement of the designated MaC.
For more information, go to:
www.cms.hhs.gov/MedicareContractingReform

in February 2008, CMS posted CMS RaC Status Document

2007 and in June 2008, CMS posted CMS RaC
Demonstration Evaluation Report..
For more information, go to: www.cms.hhs.gov/RaC
coNtiNued oN Next page
a nEWSl E t t ER a BOut h Ea lt h Ca R E Qua lit y iM PRO vE ME n t

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).

The activities related to acute IPPS hospital and

LTCH claims review which will continue to be
performed by the QIOs are:
Quality of care reviews due to beneficiary
complaints, complaints other than from
beneficiaries, and quality of care reviews
for cases referred by CMS or CMS
designated entities (e.g.; FIs, Carriers,
MACs, SSAs, OIG)
Utilization reviews for hospital requested
higher-weighted DRGs
Utilization reviews referred by CMS or CMS
designated entities (e.g.; FIs, Carriers,
MACs, SSAs, OIG.) for cases involving
issues such as transfers and readmissions
Review of Emergency Medical Treatment
Active Labor Act (EMTALA) cases
Expedited determinations
Provider education on quality of care issues,
and other issues under their purview (e.g.;
hospital-requested higher weighted DRG
review, etc.)
For more information go to: http://www.cms.hhs.
gov/AcuteInpatientPPS/downloads/
InpatientReviewFactSheet.pdf
Jennifer Bitterman, MBA, RHIA
Review Director, jbitterman@ohqio.sdps.org

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

To begin go to: www.ohiokepro.com/slm

6

Spot l ight o n Q u al i t y Fal l 2 0 0 8

TeN WAyS To BeAT THe

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.

Rates of Infections that are Antimicrobial-Resistant

Figure 1

the good news is that MRSa is preventable by

following standard infection control guidelines.
Follow the ten practices below to prevent the
transmission of infection and beat the MRSa
superbug.
1. active surveillance in critical care units,
surgery suites, emergency departments or
consider all admissions
2. Keep patient care environment clean; clean
patient rooms and care areas regularly and
properly with correct disinfectants
3. use antimicrobials only when there is an
identified infection
4. Remove all catheters as soon as possible

5. Staff education everyone is accountable for

knowing their roles and responsibilities for
preventing MRSa transmission
6. Patient and family education encourage
family members to stay home if they are sick
and wash their hands regularly before and
after being in patient rooms
7. use masks for coughing patients, family
members and staff
8. use standard contact precautions; be sure
that contact precautions are up to date and
that they are routinely reviewed with staff
9. Practice effective hand hygiene wash
hands before and after patient contact
10. leadership involvement promoting and
supporting prevention through conversations
with front-line staff about patient safety,
holding staff accountable for reliable
performance of basic infection control
practices and providing necessary supplies
and resources for staff to get the job done
Ann Fitzsimons, RN, MBA
Quality Improvement Specialist,
afitzsimons@ohqio.sdps.org

Source: CDC. MRSA in Healthcare

Settings. http://www.cdc.gov/ncidod/
dhqp/ar_mrsa_spotlight_2006.html,
last updated 10/3/07. Last accessed
8/27/08.

a nEWSl E t t ER a BOut h Ea lt h Ca R E Qua lit y iM PRO vE ME n t

Preventing Pressure Ulcers in the

Acute Care Setting

Pressure ulcers can cause significant harm to patients. Not only are they
painful, but they can also impede functional recovery and lead to infection
or even death. Although pressure ulcers are preventable in most cases, they
are becoming more and more prevalent. According to a 2003 article in the
Journal of the American Medical Association, an estimated 2.5 million
patients are treated for pressure ulcers in acute care facilities in this
country each year. JAMA further reports that incidence rates vary
considerably by clinical setting, ranging from 0.4 percent to 38 percent in
acute care; from 2.2 percent to 23.9 percent in long-term care; and from 0
percent to 17 percent in home care.
Financial Incentives and Deficiency Patterns
Recently, the National Quality Forum and the
Centers for Medicare & Medicaid Services
(CMS) have placed an increased focus on
hospital-acquired pressure ulcers. Beginning
October 2008, CMS will discontinue the
reimbursement of care for hospital-acquired

pressure ulcers. This includes cases that lack

documentation of a pressure ulcer within 24
hours of admission to the acute care facility.
In nursing homes, the number of healthcare
deficiencies for pressure ulcer prevention and
treatment is increasing, with approximately one
in five nursing homes in Ohio cited for deficient
practices between May 2007 and May 2008.
Regulatory concerns aside, nursing homes in
Ohio also have a financial incentive to reduce
the number of pressure ulcers: if a facility has
healthcare deficiencies, they receive less
Medicaid funding.
Whats the bottom line on pressure ulcers for
healthcare providers? With pressure ulcers
linked to reimbursement rates, consistent and
appropriate documentation of skin inspections,
risk assessments and preventive interventions is
more important than ever.
IHI 5 Million Lives Campaign
In an effort to protect patients from medical
harm, the Institute for Healthcare Improvement
(IHI) began the 5 Million Lives Campaign in
December 2006. The 5 Million Lives Campaign

Spot l ight o n Q u al i t y Fal l 2 0 0 8

defines medical harm as unintended physical

injury resulting from or contributed to by
medical care (including the absence of indicated
medical treatment), that requires additional
monitoring, treatment or hospitalization, or that
results in death. Such injury is considered harm
whether or not it is considered preventable,
resulted from a medical error, or occurred
within a hospital.

The IHI 5 Million Lives

Campaign considers the
development of a pressure ulcer
as an incident of medical harm.
Recognizing that many efforts have already
been made by healthcare providers to prevent
pressure ulcers, the IHI has attempted to
uncover some of the reasons that this clinical
condition remains a persistent matter. In a 2007
article that appeared in The Joint Commission
Journal on Quality and Patient Safety, IHI
Faculty Member Kathy Duncan noted, For
years, healthcare organizations have tried to
prevent pressure ulcers, but have lacked reliable
strategies as well as a long-term commitment to
prioritize and design caregivers work so that
prevention remains a priority.
As outlined by the campaign, certain strategies
have proven effective in preventing pressure
ulcers. Implementing these changes throughout
an entire facility requires an organizational
commitment and a standardized approach.
According to the IHI, pressure ulcer prevention
entails two major steps: (1) identification of
patients who are at risk and (2) reliable
implementation of prevention strategies for all
patients who are identified as being at risk.
To identify patients at risk, the IHI recommends
the following:
Conduct a pressure ulcer admission
assessment for all patients
Reassess risk for all patients daily

To implement prevention strategies, the IHI

recommends the following:
Inspect skin daily
Manage moisture
Optimize nutrition and hydration
Minimize pressure
Leasa Novak, LPN, BA Quality Improvement Specialist,
lnovak@ohqio.sdps.org and
Barbara Stiebling, RN, MSN, CPHQ Quality Improvement
Specialist, bstiebling@ohqio.sdps.org

Pressure Ulcer Statistics

Nearly one million people develop pressure ulcers each year.
Approximately 60,000 acute care patients die from related
complications.
The cost of treating a pressure ulcer is between $500 and $70,000 and
includes such things as treatment and dressing supplies, consults,
staff time and labor.
The total cost for treatment nationally in the US is estimated at $11
billion per year.
Sources:
Institute for Healthcare Improvement. Relieve the pressure and reduce harm. www.ihi.org/IHI/Topics/PatientSafety/
SafetyGeneral/ImprovementStories/FSRelievethePressureandReduceHarm.htm. Accessed May 21, 2007.
Redelings, MD. Lee, NE, Sorvillo, F. Pressure Ulcers: More lethal than we thought? Advances in Skin and Wound Care. 2005. 18
(7):367-372.
Reddy M, Gill SS, Rochon, PA. Preventing pressure ulcers. A systematic review. JAMA 2006;296:974-984

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

Joint Commission Journal on Quality and Patient Safety, 2007;

33(10):605-610.
Institute for Healthcare Improvement www.ihi.org
Lyder, CH., Pressure ulcer prevention and management. JAMA
2003; 289(2):223-226.

A newslet t er a bout h ea lt h ca re qua lit y impro vemen t

Reconsidering Physical Restraint Use in 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

200 deaths occur every year as a result of strangulation or suffocation from

restraints, even when they are applied according to manufacturers
instructions.3

Physical restraints can have harmful effects on

Do physical restraints help reduce falls?
nursing home residents. As caregivers and
No. The routine use of restraints does not lower
nursing professionals, it is imperative that we
the risk of falls or fall injuries. They can actually
thoroughly understand the laws, risks, and
add to the risk of fall-related injuries and
alternatives pertaining to restraint use. The
deaths.4 Thus, they should not be used as a fall
Long-Term Care Resident Assessment
prevention strategy.5
Instrument (RAI) Users Manual Version 2.0
associates the following negative consequences
Furthermore, limiting a patients freedom to
with restraint use:
move around leads to muscle weakness and
Strangulation
reduces physical function.6
Loss of muscle tone
Decreased bone density (with greater
Since federal regulations took effect in 1990,
susceptibility for fractures)
nursing homes have reduced the use of physical
Pressure ulcers
restraints.7 Some nursing homes have reported
Decreased mobility
an increase in falls since the regulations took
Depression and agitation
effect, but most have seen a drop in fall-related
Loss of dignity
injuries.8
Incontinence and constipation
Leasa Novak, LPN, BA,
Death
Quality Improvement Specialist, lnovak@ohqio.sdps.org and
Deborah Shaeffer, LPN,
Furthermore, indiscriminate use of restraints,
Quality Improvement Specialist, dshaeffer@ohqio.sdps.org
such as for the convenience of the staff, not
only violates residents rights to freedom and
dignity, but has also been associated with higher
rates of injury and injuries associated with falls,
precisely the conditions that the restraints are
intended to prevent.

10

S pot l ight o n Qu a l i t y Fa l l 2 0 0 8

 DC. Health, United States, 2004.

C
http://www.cdc.gov/nchs/data/hus/
hus06.pdf, last accessed 8/27/08.
2
CMS RAI Version 2.0 Manual Appendix
C, Page C-99.
3
Guttman R, Altman RD, Karlan MS.
Report of the Council on Scientific
Affairs. Use of Restraints for Patients
in Nursing Homes. Council on
Scientific Affairs, American Medical
Association. Archives of Family Medicine.
1999; 8(2): 101-5.
4
Rubenstein LZ, Josephson KR,
Robbins AS. Falls in the nursing
home. Annals of Internal Medicine
1994;121:44251.
5
Capezuti E, Evans L, Strumpf N.
Physical restraint use and falls in
nursing home residents. Journal of the
American Geriatrics Society
1996;44:62733
6
Rubenstein LZ. Preventing falls in the
nursing home. Journal of the American
Medical Association
1997;278(7):5956.
7
Rubenstein et al. 1994
8
Ejaz FK, Jones JA, Rose MS. Falls
among nursing home residents: an
examination of incident reports before
and after restraint reduction programs.
Journal of the American Geriatrics Society
1994;42(9):9604.
1

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.

Continued on next page

A newslet t er a bout h ea lt h ca re qua lit y improvemen t

11

from page 13

These non-reimburseable conditions mark the

beginning of a new trend in the Medicare/
Medicaid system to cut costs. When this new
payment rule was finalized in July 2008, CMS
also sent a letter to state Medicaid directors
providing information about how states can
adopt the same never events practices. Nearly 20
states already have or are considering methods
to eliminate payment for some never events.
In 2009, the following three events are planned
to be added to the non-payment list:
1. Surgical site infections following certain
elective procedures, including certain
orthopedic surgeries and bariatric surgery for
obesity
2. Certain manifestations of poor control of blood
sugar levels
3. Deep vein thrombosis of pulmonary embolism
following total knee replacement and hip
replacement procedures.

Again, these occurrences will not be reimbursed

unless the medical record shows that they were
present upon admission.
At the same time, CMS is also in the process of
developing three National Coverage
Determinations (NCDs) that would address
Medicare coverage of certain surgical procedures
and set national policy on whether Medicare will
cover an item of service and under what
conditions. In the absence of an NCD, coverage
decisions are made by local contractors that
process and pay Medicare claims. The three
types of surgery under consideration are surgery
on the wrong body part, surgery on the wrong
patient, and wrong surgery occurrences. The
Medicare NCD program is slated to begin in
2009.
Evaluating coverage of these procedures and
refusing payment for preventable occurrences
are yet two more important steps for Medicare in
addressing concerns regarding never events.
Susan Ferrante, ARM
Quality Improvement Specialist, sferrante@ohqio.sdps.org

12

S pot l ight o n Qu a l i t y Fa l l 2 0 0 8

October

19

26

28

21

14

29

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31

24

17

10

25

18

11

Saturday

Monday

November
Tuesday Wednesday Thursday

Friday

23
30

16

24

17

10

25

18

11

26

19

12

27

20

13

28

21

14

Sunday

29

22

15

Saturday

28

21

14

Sunday

29

22

15

Monday

December

30

23

16

31

24

17

10

25

18

11

Tuesday Wednesday Thursday

Tear this calendar out and post it as a reminder of upcoming deadlines and events.

30

23

16

Friday

26

19

12

Friday

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.

Memorandum of Agreement (MOA)

Patient Safety Events

Reporting Hospital Quality Data for Annual Payment Update

(RHQDAPU)

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

November 15, 2008 Hospitals or vendors to submit second quarter

2008 inpatient quality measure data to the clinical data warehouse.

December 1, 2008 Hospital outpatient quality measure comparative

graphs to be mailed to hospital QI contacts and uploaded to their
inboxes on www.qualitynet.org.

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

All Ohio Healthcare Providers

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/.

October 19-20, 2008 National Healthcare Quality Week. For more

information, 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 1, 2008 CEO/Administrators of all Ohio healthcare facilities

targeted to receive QIO Memorandum of Agreement (MOA).

October 8, 2008 Submit June 2008 dry run data and second quarter
2008 HCAHPS Survey Data to the Clinical Data Warehouse.

November

October

27

20

13

Saturday

Reporting Hospital Quality Date for Annual Payment Update (RHQDAPU) Program Calendar 4Q08 reporting deadlines:

27

20

13

15

12

Tuesday Wednesday Thursday

Monday

Sunday

14

S pot l ight o n Qu a l i t y Fa l l 2 0 0 8

Drugs to Avoid with

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.

Fick DM, Waller JL, Maclean JR, et al. Potentially

inappropriate medication use in a Medicare managed
care population: association with higher costs and
utilization. J Managed Care Pharm. 2001;7:407-413

Sources:

To learn more about an Ohio quality improvement initiative

focused on potentially inappropriate medications and
drug-on-drug interactions, please contact Bonnie Hollopeter
or Sue Ferrante at 1.800.385.5080.
By Bonnie Hollopeter, LPN, CPHQ, CPEHR,
Project Manager, bhollopeter@ohqio.sdps.org

Elderly Patients

Required Medicare Notices of Non-Coverage

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

Benefits Improvement and Skilled nursing facilities,

Two days prior to
Protection Act (BIPA)
home health agencies,
discharge/skilled
Notice and Medicare
hospices, and comprehensive services ending (or
Advantage (MA) Notice
outpatient rehabilitation
two visits prior to

facilities
the last visit)

Not given for a

reduction in service

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.

Jennifer Bitterman, MBA, RHIA

Review Director, jbitterman@ohqio.sdps.org
A newslet t er a bout h ea lt h ca re qua lit y improvemen t

15

rock run center, suite 100

5700 lombardo center drive
seven hills, oh 44131

all material presented or referenced herein is intended

for general informational purposes and is not intended
to provide or replace the independent judgment of
a qualified healthcare provider treating a particular
patient. ohio kepro disclaims any representation or
warranty with respect to any treatments or course of
treatment based upon information provided.
publication No. 900100-oh-025-9/2008. this material
was prepared by ohio kepro, the medicare quality
improvement organization for ohio, under contract
with the centers for medicare & medicaid services
(cms), an agency of the u.s. department of health
and human services. the contents presented do not
necessarily reflect cms policy.

TeLL uS

What you think

SPOTLIGHT

this is the first edition of the Ohio KePRO Spotlight on

Quality quarterly newsletter. What do you like about it?
What kind of information would be helpful to include?
E-mail your comments to webmaster@ohiokepro.com

oN

Fall 2008

Vol. 6 No. 4

Spotlight on Quality Quarterly newsletter providing news, events and best

practices in Ohio healthcare
Information Updates Receive timely notifications on available Ohio KePRO
educational and training opportunities, industry regulatory updates and other
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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

2
3
5
6
7
8

reCOnSIderInG PHySICaL reSTraInT uSe

In THe nurSInG HOme

10

medICare TO reFuSe PaymenT FOr PrevenTaBLe

OCCurrenCeS In OCTOBer wITH mOre TO FOLLOw

druGS TO avOId wITH eLderLy PaTIenTS

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13
14

requIred medICare nOTICeS OF

nOn-COveraGe aT a GLanCe

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CaLendar/remInderS

SuBSCrIBe TO Our e-newSLeTTerS