SPOTLIGHT

ON

WINTER 2009 | VOL. 7 NO. 1 | 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

REMEMBER WHEN?
COLORECTAL CANCER SCREENING DEMONSTRATION PROJECT
NURSING HOME RESIDENT AND HOSPITAL
PATIENT SAFETY CULTURE SURVEYS
REGULATORY UPDATE
MEDICARE CASE REVIEW SERVICES
OHIO PARTICIPATES IN STATE QUALITY INSTITUTE INITIATIVE
THE CAMPAIGN CONTINUES: ADVANCING EXCELLENCE, YEAR 3
CONTINUING EDUCATION FOR NURSES
DRUG SAFETY PROJECT
CALENDAR/REMINDERS
WELCOME TO MEDICARE PHYSICALCHANGES
TAKE A SHOT AT PREVENTION

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Remember When?

here was a timea time that many of us are loath to admit

that we rememberwhen we had bankbooks. The teller wrote
all deposits and withdrawals into that little book. Not long ago,
we picked up the telephone and told the operator to whom we wished
to speak. It was amazingit worked, or did it? Then, when we werent
looking, progress happened. Bank statements are computerized, most
transactions are electronic, and we make payments over the Internet.
Operator-assisted calls are history; now, we demand cell phones
with speed-dial, not to mention built-in cameras, MP3 players, text
messaging, e-mail and even video broadcasts. Technology: we take
it all for granted.

Too bad similar progress has not yet uniformly

come to the one industry upon which our
very lives depend. We all know, in truth, that
drug errors occurfar too frequently. The
Institute of Medicine estimates that over 1.5
million Americans are injured every year by
drug errors. These errors occur not because
of doctors, or nurses, or pharmacists or other
professionals, but despite the best eorts of
dedicated healthcare providers who care deeply
about patients and who struggle every day to do
their best in a dicult environment. Electronic
banking, automated tax preparation software,
and computerized airline reservations all reduce
errors and allow bankers, accountants and
airline personnel to function more eciently
and provide better service. As physicians, we
should look to electronic prescribing to help all
of us achieve what we strive constantly to do:
deliver better care.

We all know, in truth, that drug

errors occur-far too frequently.
Lets admit it, that e-prescribing systems can
improve patient safety and quality of care
is beyond debate. Illegible prescriptions are
avoided and integrated clinical decision support
systems can check automatically for possible
drug-drug interactions, allergies, dosing errors,
2 SPOTLIGHT ON QUALITY WINTER 2009

duplication of therapy and other patient

factors. Think how often you need to check
a patients insurance coverage and drug
formularies. How long does that take?
E-prescribing systems can simply and
easily provide you with this information
instantaneously. The creation of an electronic
record facilitates data exchange between
healthcare providers, and prevents loss of
information. In addition to the clinical
rationale, there is now a strong business
case for e-prescribing. The time devoted to
managing prescription complexities has been
valued at over $15,000 per year, per physician.
Beginning in 2009, Medicare will provide
incentive payments to professionals who use a
qualifying e-prescribing systemand starting
in 2012, providers who do not will experience
a reduction in payment. Better patient care,
better bottom line: its a win-win situation.

Times changee-prescribing is here to stay.

Some day in the not-too-distant future, it will
be the de facto standard of care. Someday, we
will say that there was a timea time that
many of us would be loath to admit that we
rememberwhen doctors wrote prescriptions
on little pieces of paper that patients actually
carried to the pharmacy. It was amazing that it
workedor did it?
What took us so long to change?

- Ronald A. Savrin, MD, MBA

Medical Director
rsavrin@ohqio.sdps.org

Colorectal Cancer Screening

Demonstration Project
The Ohio Academy of Family Physicians
(OAFP) recently hosted a training session
to increase colorectal cancer (CRC)
screening by streamlining procedural

processes. Clinical and nonclinical sta from

seven Ohio practicesincluding Eastside
Family Medicine (Cleveland), Pedro A.
Ballester, MD Family Practice (Warren),
and St. Lukes Hospital/University of
Toledo Family Medicine Center (Toledo)
were selected to participate in the two-day
training program.
Ohio KePRO worked with OAFP and the American
Cancer Society (ACS) at the event, facilitating breakout
groups and working one-on-one with attendees to help
them customize oce protocol for identifying at-risk
patients, and for recommending appropriate screenings.
Participants received a copy of How to Increase Colorectal
Cancer Screening Rates in Practice, the toolkit that served as
a template for the quality improvement project. The toolkit
is available for electronic download at the ACS Web site
(www.cancer.org), and includes a wealth of information on
this important topic, including:

Checklists
Best practices for broaching the topic with patients
Methods for determining risk
Algorithms
Tips on how to set up reminders

The ACS Web site also includes patient reference tools

such as a personalized online planner to keep track of
appointments and treatment milestones, and the Cancer
Survivors Network, which features discussion boards and a
chatroom.
Aecting more than 140,000 Americans every year,
colorectal cancer is a serious disease that demands serious
attention. CMS has included CRC screening as one of
the four measures in the Prevention Theme in the current
9th Statement of Work, and Ohio KePRO will be working
with practices to improve rates by 15 percent in the next
two years.
Look for updates on this quality improvement project in
future issues of Spotlight on Quality.

A NEWSLETTER ABOUT HEALTHCARE QUALITY IMPROVEMENT 3

Nursing Home Resident

And Hospital Patient Safety
Culture Surveys:

A CORNERSTONE OF PERFORMANCE
IMPROVEMENT

Every nursing home or healthcare facility has its own culture, which diers from
unit to unit, and department to department. It consists of an overall organizational
culture and various subcultures. The collective subcultures impact the organizational
culture and, ultimately, the delivery of care to beneciary residents/patients. One of
these is the safety culture, or the collective product of individual and group values
and attitudes, competencies and patterns of behaviors in safety performance. It is,
whether positive or negative, simply the way we do things around here.
In Managing the Risks of Organizational
Accidents (1997), human error guru James
Reason was the rst to emphasize the
foundational importance of a good safety
culture. According to Reason, the hallmarks
of a culture of safety include a climate in
which people are prepared to report errors and
near-misses, and a just atmosphere in which
there is a clear distinction between acceptable
and unacceptable behavior. This kind of
environment is exible, and emphasizes
teamwork.

Just as a surgeon orders comprehensive diagnostic,

physiological testing before operating on a
patient, nursing home and healthcare facilities
should conduct careful, periodic assessments as
a diagnostic indication of the sta perception
of the resident/patient safety culture at the
organizational and unit level. A tool utilized by
the Centers of Medicare & Medicaid Services
(CMS) in the 9th Statement of Work (SOW) to
measure sta perception of organizational culture
and subcultures is the Agency for Healthcare
Research & Quality (AHRQ) Nursing Home
Resident and Patient Safety Culture
Surveys.
Such an assessment is important,
but it is only one step in an ongoing
process. Changing the way people
act and think about safety is not easy,
and it is imperative to recognize and
acknowledge that culture change is not a
program. A program, by denition, has
a beginning and an endbut culture
change is a process. It is imperative to
rst establish a clearly dened shared
mental model of your organizations
commitment to patient safety. This
starting point, when embraced, can
help bring lasting change.

CONTINUED ON NEXT PAGE

4 SPOTLIGHT ON QUALITY WINTER 2009

FROM PAGE 4

The AHRQ Resident/Patient Safety Culture

Surveys measure twelve dimensions of culture
that are crucial to the success or failure of safety
initiatives. The value of this measurement is
coupled with its importance as a diagnostic tool
for launching the organization into a culture
change that will facilitate a leap in performance.

A step-by-step approach to changing resident/

patient safety cultures includes:
Shared Mental Model. Use frontline sta
input to establish a shared mental model
of the organizational safety culture. Clear,
consistent communication of the model
throughout the organization is imperative.
Resident/Patient Safety Culture
Assessment.
Use the AHRQ Nursing Home Resident
and Hospital Patient Safety Culture Surveys
to identify organizational and unit-specic
perceptions of culture strengths and
weaknesses.
Strategies/Action Plans.
Partner with frontline sta to develop
strategies and action plans to realize desired
changes, while allocating resources, personnel,
training and time to resident/patient safety
culture initiatives.
Empower Sta.
Implement strategies to empower and
support sta, and communicate accountability
of all sta for resident/patient safety
organizational objectives and initiatives.
Ongoing Evaluation/Assessment.
Conduct ongoing evaluation of project
progress and resident/patient safety culture
perception survey results.

In a successful culture of
safety, everyone must accept
responsibility for patient safety.
It is important to keep in mind that an ongoing
organizational commitment is necessary to
sustain performance improvements. Your Ohio
KePRO quality improvement specialist and
project coordinator will assist your organization
in the survey process, and can help your
organization develop individualized action
plans.
As with all quality improvements, assessing
culture is not a one-time event, but rather, a
process. A rst assessment yields data to
aid in the design process improvements,
but subsequent assessments are crucial in
determining the eectiveness of the chosen
course of action.

It is also of paramount importance for

leadership and each physician, director,
manager and caregiver to be an equal partner
in improving resident/patient safety. In a
successful culture of safety, everyone must accept
responsibility for resident/patient safety. Ohio
KePRO has tools and resources to help your
facility make quality improvements throughout
your organization.

Our quality improvement specialists and the

rest of the Patient Safety team look forward to
assisting 9th SoW participants on our journey
toward the goal of providing excellent, quality
and evidenced-based care to all Ohios Medicare
beneciaries.
- Rita Bowling, MSN, MBA, CPHQ
Project Director
rbowling@ohqio.sdps.org
- Susan L. Ferrante, ARM
Quality Improvement Project Coordinator
sferrante@ohqio.sdps.org
A NEWSLETTER ABOUT HEALTHCARE QUALITY IMPROVEMENT 5

REGULATORY

UPDATE

FY 2010 Quality Measures Data Reporting

In the nal scal year (FY) 2010 Inpatient Prospective
Payment System (IPPS) Rule, one of the 30 previous quality
measures (PN-1 Oxygenation Assessment) is being retired,
and 13 new measures were added to the Reporting Hospital
Quality Data for Annual Payment Update (RHQDAPU)
program for FY 2010 payment determination. The new
measures are:

Surgical Care Improvement Project (SCIP)

SCIP-Card-2: Surgery patients on a beta-blocker

prior to arrival who received beta-blocker during the
perioperative period

Nursing Sensitive Measures

Failure to Rescue

Readmission Measures

Heart Failure Readmission

(Acute Myocardial Infarction Readmissions and Pneumonia

Readmissions were added in the CY 2009 OPPS/ASC nal
rule with comment period.)

AHRQ Quality Indicators: Inpatient Quality

Indicators and Patient Safety Indicators
Death among surgical patients with treatable
serious complications
Iatrogenic pneumothorax, adult
Postoperative wound dehiscence
Accidental puncture or laceration
Abdominal Aortic Aneurysm (AAA) mortality rate
(with or without volume)
Hip fracture mortality rate
Mortality for selected medical conditions
(composite)
Morality for selected surgical procedures
(composite)
Complication/patient safety for selected indicators
(composite)

Cardiac Surgery Measures

Participation in a Systematic Database for

Cardiac Surgery

SCIP-Card-2 is eective with 1Q09 discharges. The rest

of the new measures will be calculated from Medicare
Claims Data for index hospitalizations covering the
period of July 1, 2007 through June 30, 2008 (3Q07
2Q08 discharges).

Contact Fran Hober at fhober@ohqio.sdps.org or (216)447-9607, ext. 2115 with any questions about CMS public
reporting program changes and deadlines.

Now Available

ICD-10-CM/PCS Fact Sheet

A fact sheet on the International Classication of Diseases,

10th Edition, Clinical Modication/Procedure Coding System
(ICD-10-CM/PCS) is now available in print format from the
CMS Medicare Learning Network. The fact sheet includes
information on the benets of adopting the new coding system,
structural dierences between ICD-9-CM and ICD-10-CM/

6 SPOTLIGHT ON QUALITY WINTER 2009

PCS, and recommendations for implementation planning.

To place your order, visit www.cms.hhs.gov/MLNProducts/01_Overview.asp, scroll down to Related Links Inside
CMS and select MLN Product Ordering Page.
An overview of ICD-10 is also available at www.cms.hhs.
gov/ICD10.

Medicare Case Review Services

QUALITY IMPROVEMENT
PROJECTS
The Ohio KePRO Quality
Improvement Committee has been
working with providers to improve
the quality of patient care they
provide and enhance the overall
healthcare experience. Together,
they have identied areas of
concern serving as the impetus for a
wide variety of quality improvement
projects (QIPs). The following are
just a few recent examples:

QUALITY IMPROVEMENT PROJECT #1

Concern 1: The patient continued to receive Coumadin
and ASA with the presence of hematuria, vaginal and
rectal bleeding.
Concern 2: It is documented that this patient was
having moderate to severe pain. There was no
documentation of a pain assessment, if pain medication
was given, or the eectiveness of the pain medication in
the nursing notes.
Concern 3: A review of the medical record indicated
that the nursing sta failed to recognize, treat and
notify the attending physician of this patients diarrhea,
hypotension, dehydration and bleeding.
Concern 4: There was an order for PT/INR every
Monday and Thursday, which was not carried out. The
PT/INR was conducted just twice during the patients
two-week stay.
(This case was determined to be one of gross and agrant
negligence. It went before the sanction board, which ruled
that an intensied review should be initiated.)
QUALITY IMPROVEMENT PROJECT #2
Concern: Delay in notication of medial wall fracture
of proximal femur to patient and physician. (There
was a three-day delay in reporting critical radiology
test results.)

We view every concern as an

opportunity to improve the quality
of patient care.

QUALITY IMPROVEMENT PROJECT #3

Concern 1: The patients oral intake was poor, and this
inability to eat, accompanied by nausea and vomiting,
was not adequately assessed and addressed
by the physician.
Concern 2: BUN 99 and Creatinine 3.4 were not
evaluated or addressed by the physician, and the
patients complaints were not addressed.
QUALITY IMPROVEMENT PROJECT #4
Concern: The radiologist interpreted and/or dictated
the CT angiogram of the head and neck incorrectly.
The radiology report indicated that the right carotid
artery had 80 percent stenosis. The surgeon requested
another reading, due to the fact the patient had right
carotid artery repair previously. The reading was later
corrected by an addendum noting that the condition
was left carotid artery stenosis.
These projects are monitored by the Quality Improvement
Committee, which provides feedback to providers.
This feedback comes through Ohio KePRO quality
improvement specialists, who provide guidance and
resources, make site visits, and work with providers to help
them make each QIP a success. We view every concern as
an opportunity to improve the quality of patient care.
- Mary Daughters, LPN
Review Services Project Leader
mdaughters@ohqio.sdps.org

A NEWSLETTER ABOUT HEALTHCARE QUALITY IMPROVEMENT 7

OHIO PARTICIPATES IN

State Quality
Institute Initiative
arlier this year, Ohio was recognized as a national leader when it was selected to
participate in the Commonwealth Fund/Academy Health State Quality Improvement
Institute (SQII). With state selection criteria based on commitment, leadership and
resources, the SQII is an intensive eort to help states plan and implement concrete
action plans to improve health system performance across targeted quality indicators.
Also selected for participation were Colorado, Kansas, Massachusetts, Minnesota, New
Mexico, Oregon, Vermont and Washington. Enrique Martinez-Vidal, vice president
at AcademyHealth, noted, These nine states are best positioned to take immediate
advantage of the Institutes resources and move forward with ongoing improvement
eorts in their home states.
State SQII teams include key stakeholders from the public and private sector,
including state-level government ocials, private payors and employers, and
healthcare providers and institutions. Led by the Governors Oce, the Ohio SQII
Team assembled members of the healthcare community to participate in a three-day

Ohio Health Quality Improvement Summit

(OHQIS) in mid-November. Participants
worked to identify the top 10 transformative
strategies to help the state achieve, by 2013, a
high quality, high-performing, cost-eective
system to optimize the health of Ohioans.
Support for OHQIS came from
organizations across the state, including
AARP Ohio, Anthem, HealthBridge,
Nationwide, the Ohio Association of Health
Plans, the Ohio Nurses Association, the Ohio
Osteopathic Association, OSU Academic
Health Center, and Sisters of Charity
Foundation of Cleveland. Speakers at the
event included Governor Ted Strickland;
Alvin Jackson, MD, Director of the Ohio
Department of Health; Bruce Bagley, MD,
Medical Director for Quality Improvement at
the American Academy of Family Physicians
(AAFP); and Anne-Marie J. Audet, MD,
MSc, Vice President of Quality Improvement
and Eciency at the Commonwealth Fund.

Summit participants worked to identify the top 10 strategies

to help the state achieve a high-quality, high performing,
cost eective system to optimize the health of Ohioans.
8 SPOTLIGHT ON QUALITY WINTER 2009

Areas of focus at the Summit were:

Improving patient safety and reducing
errors
Promoting health through personal
responsibility and disease and injury
prevention
Improving chronic care management
Improving eciency and decreasing
cost.

Ohio KePROs Bonnie Hollopeter, LPN,

CPHQ, CPEHR, CPHIT, was present at the
event, and served as a member of the Chronic
Care Management Focus Team. She and
other participants considered specic tactics
related to health information technology,
payment reform, health disparities and
workforce retention.
Acting in pursuit of SQII goals, the Ohio
SQII Team plans to follow up by:

Setting up a State Implementation

Team to align quality improvement
activities throughout the state
Disseminating a report in December to
summarize Summit learnings and solicit
feedback
Reconvening Summit attendees in
Spring 2009 to discuss next steps.

For more information about the SQII, visit

www.academyhealth.org/state-qi-institute.

THE CAMPAIGN CONTINUES:

ADVANCING EXCELLENCE, YEAR 3
Its not too late for your nursing home to join!
Originally planned as a twoyear eort to end September
2008, Advancing Excellence in
Americas Nursing Homes has
resulted in signicantly improved
care for nursing home residents.
Consequently, the decision has
been made to continue this national
campaign indenitely.
Nearly half (45%) of nursing homes in the
country have joined the campaign and are
taking advantage of free educational resources
on the campaign Web site. Educational
resources include tools such as process
frameworks and implementation guides,

consumer fact sheets, and Webinars, all of

which are designed to address the various
campaign goals. Ohio nursing homes that
register for the campaign receive a welcome kit
from Ohio KePRO with items to help them
get started on their selected goals.

Advancing Excellence in Americas

Nursing Homes Campaign Goals
ORGANIZATIONAL GOALS

CLINICAL GOALS

Reducing high-risk pressure ulcers

Reducing the use of physical restraints
Improving pain management for longterm residents
Improving pain management for short
stay residents

Establishing targets to improve quality

Assessing resident and family satisfaction
Increasing sta retention
Implementing consistent assignment for
sta

CONTINUED ON NEXT PAGE

A NEWSLETTER ABOUT HEALTHCARE QUALITY IMPROVEMENT 9

FROM PAGE 9

Havent registered yet?

Consider these preliminary results from the

National Steering Committee:

Nursing homes that register for the

campaign are making faster improvement
toward clinical goals than homes that
don't register.
Nursing homes that register for the
campaign and select a particular clinical
goal improve faster on that goal than
homes that do not select that goal.

Nursing homes that not only select a goal,

but also target how much they aim to
improve, improve faster than homes that
do not set targets.

Are you ready to register?

Simply go to www.nhqualitycampaign.org and

click on Join the Campaign.
You will be asked to select three campaign goals
(including at least one clinical goal and one
organizational goal).

Did You Know?

Nearly half of nursing homes
in the country have joined the
Advancing Excellence Campaign.
Not sure if your home has registered
already? Go to www.nhqualitycampaign.org and click on Find Participants to check the listings for Ohio.
- Leasa Novak, LPN, BA
Quality Improvement Project Coordinator
lnovak@ohqio.sdps.org

Continuing Education for Nurses

Learn something new and earn continuing education credits! Ohio KePRO oers
free self-study modules with continuing education credits for nurses. Register, download, and print the learning packets at www.ohiokepro.com/providers/education.asp.
Current self-study modules: Benets Improvement and Protection Act and Going
Nowhere with Restraints.

10 SPOTLIGHT ON QUALITY WINTER 2009

Drug Safety Project

n the new Quality Improvement Organization (QIO) contract cycle
that began August 1, 2008, the Centers for Medicare & Medicaid
Services (CMS) dened the Drug Safety project as needing to target
the Drug-Drug Interaction (DDI) and Potentially Inappropriate
Medication (PIM) measures. The project allows for individual QIOs
to design a study and use the interventions most appropriate in each
state. The approach that Ohio KePRO plans to use for this project is
briey described here.

OBJECTIVE: To reduce the number of

potentially adverse events associated with DrugDrug Interactions or Potentially Inappropriate
Medications in the Medicare population in Ohio.
BACKGROUND: Ohios 1.9 million Medicare
beneciaries are served by one of the states 15
Medicare Advantage (MA) plans, or one of the
states 27 Part D prescription drug sponsors.
All of the MA plans include prescription drug
plans, and most of the drug sponsors are national
organizations with representation in Ohio.
The Medicare beneciary population has been
shown to be at great risk for medication-related
problems due to the quantity and types of
prescription and nonprescription medications, agerelated physiological changes, and multiple chronic
diseases and conditions common in this age group.1
Medication-related problems have been found
to be associated with as many as 200,000 deaths
annually in the U.S.2 While not all DDI or PIM
events produce fatalities, the potential exists to
produce serious negative health events for the
patient.
Previous study ndings which were generalized to
the entire U.S. Medicare population have shown
that only 25-33 percent of adverse drug events may
be preventable.3 The majority of the preventable
errors were found to occur during the prescribing
and monitoring stages of care.4
Studies have documented the importance of the
role that pharmacists can play in identifying and

preventing potentially negative health outcomes

related to medications.5 Likewise, all providers
and professionals who care for older adults
play an important role in their medication
management through attention to the reduction
of inappropriate prescribing, decreasing the
number of medications taken, avoiding adverse
events and maintaining function.6

Research indicates that factors such as having

multiple healthcare providers and higher
numbers of prescription medications, increases
the numbers of possible interactions for each
patient. This increases the diculty for physicians
and pharmacists to recognize possible DDIs.7
METHODOLOGY: The measures specied
for use in this project were developed by CMS.
The DDI measure is dened as the percentage
of Part D enrollees with claims for drugs
potentially interacting but cannot measure any
sequelae or specic outcome from these potential
DDI.8 The PIM measure is dened as the
percentage of Part D enrollees >65 years old
with >1 potentially inappropriate medications
(PIM).9

The Medicare beneciary

population has been shown
to be at great risk for
medication-related problems.
CONTINUED ON NEXT PAGE

A NEWSLETTER ABOUT HEALTHCARE QUALITY IMPROVEMENT 11

FROM PAGE 11

Medication-related problems are

associated with as many as 200,000
deaths annually in the U.S.
The baseline period dened by CMS for this
project is June 1, 2007 December 31, 2007;
data from Part D claims for this time period
was provided by CMS. An initial analysis of the
baseline data has shown that there were over
55,000 DDI and 99,000 PIM events during this
time. Based on the research estimates that only a
portion (25-33%) of these events are preventable,
the maximum potential for reductions of these
events is approximately 16,500 DDIs and 30,000
PIMs in this population.
INTERVENTION APPROACH: The
research discussed several areas to address in
order to decrease the incidence of DDI and PIM
events. Interventions for this project will target
these areas:
Increasing pharmacist and physician
awareness of DDI and PIM
Increasing patient and caregiver
involvement in pharmaceutical care
Enhancing prescriber-pharmacist
collaboration in all practice settings
Promoting the use of automated
monitoring
The interventions will consist primarily of
educational eorts targeting pharmacists and
prescribing physicians, to ensure awareness of
potential DDI and PIM events in their patient
populations. Baseline data will be analyzed to
identify the pharmacists, prescribing physicians,
beneciaries, and drugs that have the highest

12 SPOTLIGHT ON QUALITY WINTER 2009

percentages of identied potential DDI or

PIM events. This will be used to develop
and then distribute informational reports.
Educational information will be developed
for beneciaries, to increase the awareness
of potential DDI and PIM events, provide
greater knowledge and promote more active
participation by the beneciaries and their
caregivers in communicating with pharmacists
and prescribing physicians. The interventions
will be supported by analysis and monitoring of
DDI/PIM analytic data throughout project.

CONCLUSION: As the work on this project

ramps up and the intervention materials and
reports are developed, the information will
begin to be distributed and further details about
the progress of this project will be provided.
- Linda Stokes, MSPH, ABD
Senior Scientist
lstokes@ohqio.sdps.org
Simonson W, Feinberg JL. Medicaon-related problems in the
elderly: Dening the issues and idenfying soluons. Drugs Aging.
2005;22(7):559-569.
2
Simonson and Feinberg.
3
Simonson and Feinberg.
4
Malone DC, Hutchins DS, Haupert H et al. Assessment of potenal
drug-drug interacons with a prescripon claims database. Am J
Health Syst Pharm. 2005;62,1983-1989.
5
Simonson and Feinberg.
6
Bergman-Evans B. (2006). Evidence-based guideline improving
medicaon management for older adult clients. J Gerontol Nurs.
2006;32(7):6-14.
7
Malone, Hutchins, Haupert et al.
8
The Centers for Medicare & Medicaid Services (2006). QualityNet:
Quality Measures Management Informaon System (QMIS)
Measure ID: 10507. Available at hps://www.qualitynet.org/qmis/
measureDetailView.htm?measureId=10507&viewType=1. Accessed
November 21, 2008.
9
The Centers for Medicare & Medicaid Services (2006). QualityNet:
Quality Measures Management Informaon System (QMIS)
Measure ID: 10508. Available at hps://www.qualitynet.org/qmis/
measureDetailView.htm?measureId=10508&viewType=0. Accessed
November 21, 2008.
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ICD-10-CM/PCS National Provider Conference Call - Transcript Now Available

A transcript of the CMS ICD-10-CM/PCS National Provider Conference Call for Other Part A
and Part B Providers that was held on November 12, 2008 is now available on the CMS Web
site at www.cms.hhs.gov/ContractorLearningResources (select from the Downloads list).

Be sure to check www.ohiokepro.com for the latest developments in healthcare.

Bookmark our Web site for industry news and updates.

Reminders

National Colorectal Cancer Awareness Month

Patient Safety Events

Reporting Hospital Quality Data for Annual Payment Update

(RHQDAPU)

April 8, 2009
Submit 4Q08 survey data to the CDW.
Submit December 2008 dry run data to the CDW

April

LOOKING AHEAD:

March 8-14, 2009

National Patient Safety Awareness Week

March 1, 2009
Quality measure comparative graphs sent to QI
contacts. QI contacts may access their hospitals
reports in the inbox at www.qualitynet.org.

March

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Has your hospital experienced a change in one of 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.

Hospitals

February 28, 2009

Send CDAC chart requests for the inpatient quality
measures to your medical records contact. (Charts
will be sent within 30 days of the request.)

For All Ohio Healthcare Providers

January 19-23, 2009

National Medical Group Practice Week. For more
information, visit www.mgma.com/gpw.

February 15, 2009

Submit 3Q08 quality measures data for the inpatient
quality measures to the CDW.

February 1, 2009
Hospitals or vendors to submit 3Q08 ICD population
and sampling counts for the inpatient quality
measures to the CDW.
Submit 3Q08 quality measures data for the outpatient
quality measures to the CDW. For assistance with data
submission, contact FMQAI at hopqdrp@fmqai.com or
(866)800-8756 (M-F, 7 a.m. 6 p.m. EST).

January 14, 2009

Submit 3Q08 HCAHPS survey data to the Clinical
Data Warehouse (CDW).
Submit September 2008 HCAHPS dry run data to the
CDW.

January 18-24, 2009

Healthy Weight Week

National Cancer Prevention Month

American Heart Month

February

January 6, 2009
National Wear Red Day

January

Reporting Hospital Quality Date for Annual Payment Update (RHQDAPU) Program Calendar - 1Q09 reporting deadlines:

January

Welcome to
Medicare PhysicalChanges
CMS has recently expanded coverage for the Initial Preventive Physical
Examination (IPPE) benet, aecting physicians and providers submitting
claims to Medicare Fiscal Intermediaries (FIs), Carriers, and/or Part A/B
Medicare Administrative Contractors (A/B MACs).
Under the Medicare Improvement for Patients
and Providers Act of 2008 (MIPPA), these
changes are in eect for services performed on
or after January 1, 2009:
Deductible for the IPPE waived.
Measurement of body mass index (BMI)
included as part of IPPE.
End-of-life planning included as part of
IPPE (upon an individuals consent).
Previously mandatory screening
electrocardiogram (EKG) requirement
removed. The screening EKG is now
optional, and is permitted as a one-time
screening service as a result of a referral
arising out of the IPPE.

14 SPOTLIGHT ON QUALITY WINTER 2009

Changes to IPPE eligibility guidelines,

eective January 1, 2009:

Eligibility period extended to 12 months

after Part B enrollment (previously 6
months after enrollment).
Medicare deductible does not apply to
IPPEs performed on or after January 1,
2009.
Deductible now waived for the IPPE (code
G0402) only, but the coinsurance still
applies.
As in 2008, beneciaries will pay 20 percent
coinsurance, with no deductible for screening
colonoscopy.
More details on changes to the
IPPE benet are available at
www.cms.hhs.gov/MLNMattersArticles/
downloads/MM6223.pdf.

Take a Shot at

Prevention
Winter is well under way, and most
of us are looking forward to the
spring thawbut its not too late to
get vaccinated! The u season begins
in the fall, but u activity usually
peaks in January, with the season
lasting well into March. The u
vaccine is safe, eective and readily
available, so theres no reason for
any of us to avoid taking this simple
preventive measure.
Its especially important for healthcare providers to do so.
The Centers for Disease Control and Prevention (CDC)
and the U.S. Department of Health and Human Services
(HHS) both recommend an annual inuenza vaccination for all healthcare professionals working directly with
patients, but fewer than half (41.8%) actually do so. Because
your focus is on patient care, its easy to lose sight of your
own health, but vaccination is an important step in protecting yourself, your coworkers, and your patients.
Of course, you should also encourage patients in high-risk
groups, particularly those aged 65 and older, to get vaccinated. Each year in the U.S., the u is responsible for
36,000 deaths and 200,000 hospitalizations. Ninety percent
of these deaths and more than half of these hospitalizations
occur in the senior population, but a signicant percentage (30%) of this age group doesnt get annual vaccinations.

Seniors are at higher risk for serious u complications

because they have weaker immune systems. Those with
chronic medical conditionssuch as asthma, diabetes,
kidney disease, and cancerare even more susceptible to
illness, and should be especially proactive in getting annual
vaccinations.
For updated vaccine information and other important
u-related resources, visit the CDC Web site (www.cdc.
gov/u). The Ohio Immunization Partners for Healthy
Adults (OIPHA) section of our Web site (www.ohiokepro.
com/oipha) also oers a free informational packet on adult
immunizations for the 2008-2009 season, with key documents and tools for sta as well as for patients and residents
of long-term care facilities.

A NEWSLETTER ABOUT HEALTHCARE QUALITY IMPROVEMENT 15

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5700 Lombardo Center Drive
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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
qualied 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-081-12/2008. 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
reect CMS policy.

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