Nwewsletter Spotlight Fall 2008

8/9/2019 Nwewsletter Spotlight Fall 2008

1/16

QUALITY S P O T L I G H T FALL 2008

y VOL. 6 NO. 4 y WWW.OHIOKEPRO.CO

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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 2

TAPPING INTO YOUR ELECTRONIC HEALTHRECORDS FULL POTENTIAL 3

REGULATORY UPDATE 5

GOING NOWHERE WITH RESTRAINTS 6

TEN WAYS TO BEAT THE MRSA SUPERBUG 7

PREVENTING PRESSURE ULCERS IN THEACUTE CARE SETTING 8

RECONSIDERING PHYSICAL RESTRAINT USE

IN THE NURSING HOME 10MEDICARE TO REFUSE PAYMENT FOR PREVENTABLEOCCURRENCES IN OCTOBER WITH MORE TO FOLLOW 11

CALENDAR/REMINDERS 13

DRUGS TO AVOID WITH ELDERLY PATIENTS 14

REQUIRED MEDICARE NOTICES OFNON-COVERAGE AT A GLANCE 15


2/16

EOpening Ceremony

Like the International Olympic Committee,Ohio KePRO is also a catalyst for collaboration.

As the Medicare Quality ImprovementOrganization (QIO) for Ohio, we bring Ohiohealthcare providers together in collaborativeprojects to share successes and best practices.

Weve found that creating a learning, sharingcommunity is the best way to help providersachieve their goals.

Last month, around the same time as the 2008Olympic opening ceremonies, the QIO programembarked on a new three-year contract with theCenters for Medicare & Medicaid Services(CMS). As a result, some of Ohio KePROsservices for healthcare providers have changed.The 2008-2011 QIO contract offers newopportunities for healthcare providers toparticipate in quality improvement activities inkey areas, such as patient safety, prevention

and Medicare beneciary protection. By andlarge, QIO program resources are concentratedon helping providers that demonstrate thegreatest need and/or with the greatestopportunity for improvement on specic qualitymeasures. To read more about the new QIOcontract, go to www.cms.hhs.gov/ QualityImprovementOrgs.

With this rst edition of Spotlight on Quality, we introduce key issues that will be the focus ofthe CMS QIO program for the next three years.This newsletter is designed to be a quarterlyresource for Ohio healthcare providers for bestpractices in healthcare, quality tools, tips fromindustry experts, key dates calendar, andupdates on CMS regulations. Enjoy!

Gayle Smith, RN, MVice President of Public Programs, Ohio KePR

2 SPOTLIGHT ON QUALITY FALL 2008

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

con ict, 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.


3/16 A NEWSLETTER ABOUT HEALTHCARE QUALITY IMPROVEMENT

FULL POTENTIAL

Eighty-ve percent of physicians with a

comprehensive electronic health record systemreported a positive effect on the delivery oflong-term and preventive care that meetsguidelines, according to an article published inthe July 2008 New England Journal of

Medicine. However in the same study, onlyabout half of respondents with a basic systemnoted the same positive effect. Is it thecomprehensive system that enables thesepractices to deliver better care? Or could it bethat practices that implemented a comprehensivesystem use it for more than just documentation?

As illustrated in the gure below, it is

undeniable that most respondents felt that theirelectronic system helped them performessential job functions better.

An electronic health record is a substantial investment. In addition to monetary costs, anelectronic 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 anelectronic health record and gotten most of the bugs out of the system and processes its timeto make sure that your practice is making the most of its investment.

TAPPING INTO YOUR ELECTRONIC HEALTH RECORDS

Rates of Positive Survey Responses on the Effect of Adoption ofElectronic-Health-Records Systems

CONTINUED ON NEXT PAGE


4/164 SPOTLIGHT ON QUALITY FALL 2008

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 accessed8/29/08.

Note: Ofces with a fully functionalsystem include four minimum features:computerized orders for prescriptions,computerized orders for tests, testresults (lab or imaging), and clinicalnotes.

Healthcare is becoming increasingly focused onmeasurable results. Now more than ever,consumers are able to choose healthcare

providers based on publicly reportedinformation about providers performance.

Your electronic health record is a time-savingtool to proactively manage patient populations,set improvement goals and improve the healthof your patients. With the right care managementfunctions in place, your practice can createappropriate, measurable, and cost-effectiveintervention programs using your electronichealth record. Are you using it to its fullestpotential?

Bonnie Hollopeter, LPN, CPHQ, CPEHR

Project Manager, [email protected]

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 practicel We will have an electronic health record implemented by October 31, 2008l Our electronic health record is certied by the Certication Commission for

Healthcare Information Technology (CCHIT), which I have veried on the Web athttp://www.cchit.org/choose/ambulatory/2007/

l We would be willing to complete training and participate in a national project toimprove care management using electronic health records

l I can identify a leader and an identied physician champion within my practice thatwould support this project

l We would be willing to report data on breast/colorectal cancer screenings and u/pneumonia immunizations to Ohio KePRO and the Centers for Medicare & MedicaidServices (CMS)

If your physician practice meets these requirements, you are eligible to participate in atwo-year project to improve care management processes with the assistance of qualityimprovement specialists from Ohio KePRO. The Prevention Project will focus on using yourexisting CCHIT-certied electronic health record to improve rates of breast and colorectal

cancer screenings, as well as pneumococcal and in uenza immunizations. Participants willalso learn new skills and techniques that can be applied to other quality measures.

Benets of participation: Free consultation on care management techniques, work ow and process redesign,

and electronic data reporting Increase ef ciency 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 [email protected].

FROM PAGE 3



UPDATECentralizing Medicare Claims:

The Transition from FIs to MACs by 2011In an effort to reform the Medicare fee-for-services (FFS)system and offer a centralized resource for all Part A and Bclaims, Medicare is replacing the current scal intermediaries(FIs) and carrier contracts with Medicare AdministrativeContractors (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 trustfund a total of $900 million by the end of scal year 2010.

CMS designed 15 new MAC jurisdictions to balance thenumber of fee-for-service beneciaries and providers and tobe more alike in size than the existing FI jurisdictions,promoting greater efciency in processing Medicares billionclaims a year. To date, CMS has awarded nine out of 15 total

MAC contracts. Ohio, which is in jurisdiction 15, is stillawaiting the announcement of the designated MAC.

For more information, go to:www.cms.hhs.gov/MedicareContractingReform

Detecting Improper Payments:

Implementation of RAC Program by 2010By 2010, the Centers for Medicare & Medicaid Services plansto have four Recovery Audit Contractors (RACs) in place toensure correct payments are being made to providers andsuppliers and, therefore, protect the Medicare Trust Fund.This decisions was made after a three-year RACdemonstration projects in New York, Massachusetts, Florida,South Carolina, and California ended in March 2008.

In February 2008, CMS posted CMS RAC Status Document2007 and in June 2008, CMS posted CMS RACDemonstration Evaluation Report..

For more information, go to: www.cms.hhs.gov/RAC

REGULATORY



6/16

NEW ONLINE SELF-LEARNING MODULE1 hour continuing education credits for nursesCost: Free

Upon successful completion of this online self-study module, participants will:1. Describe the denition 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 ve 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 QIpersonnel

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

Hospital Payment Monitoring Program DiscontinuesSome Services, not AllIn an effort to align the oversight of acuteinpatient prospective payment system (IPPS)hospitals and long-term care hospitals (LTCHs),some of the QIO responsibilities under theHospital Payment Monitoring Program (HPMP)have transitioned to the scal intermediaries(FIs)/Medicare Administrative Contractors(MACs) or the Comprehensive Error Rate Testing(CERT) contractors. Therefore, Medicare FiscalIntermediaries (FIs) and Medicare AdministrativeContractors (MACs) will now conduct medicalreview to prevent improper payment of inpatienthospital claims. Medical review is the processperformed by Medicare contractors to ensure

that billed items or services are covered and arereasonable and necessary as specied undersection 1862(a)(1)(A) of the Act. In addition,the Comprehensive Error Rate Testing (CERT)contractor will now conduct medical review tomeasure inpatient hospital payment error rates.

Also, QIOs will no longer provide Program forEvaluating Payment Patterns Electronic Reports(PEPPER).

The activities related to acute IPPS hospital andLTCH claims review which will continue to beperformed by the QIOs are:

Quality of care reviews due to bene ciarycomplaints, complaints other than frombeneciaries, and quality of care reviewsfor cases referred by CMS or CMSdesignated 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 involvingissues 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 DRGreview, etc.)

For more information go to: http://www.cms.hhs.gov/AcuteInpatientPPS/downloads/ InpatientReviewFactSheet.pdf

Jennifer Bitterman, MBA, RReview Director, [email protected]


GOING NOWHERE WITH RESTRAINTS

FROM PAGE 5



TEN WAYS TO BEAT THE

MRSA SUPERBUG

The good news is that MRSA is preventable byfollowing standard infection control guidelines.Follow the ten practices below to prevent the

transmission of infection and beat the MRSAsuperbug.

1. Active surveillance in critical care units,surgery suites, emergency departments orconsider all admissions

2. Keep patient care environment clean; cleanpatient rooms and care areas regularly andproperly with correct disinfectants

3. Use antimicrobials only when there is anidentied infection

4. Remove all catheters as soon as possible

5. Staff education everyone is accountable forknowing their roles and responsibilities forpreventing MRSA transmission

6. Patient and family education encouragefamily members to stay home if they are sickand wash their hands regularly before andafter being in patient rooms

7. Use masks for coughing patients, familymembers and staff

8. Use standard contact precautions; be surethat contact precautions are up to date andthat 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 conversationswith front-line staff about patient safety,holding staff accountable for reliableperformance of basic infection controlpractices and providing necessary suppliesand resources for staff to get the job done

Ann Fitzsimons, RN, MBAQuality Improvement Specialist,

[email protected]

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 accountedfor 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

Source: CDC. MRSA in HealthcareSettings. http://www.cdc.gov/ncidod/dhqp/ar_mrsa_spotlight_2006.html,last updated 10/3/07. Last accessed8/27/08.

Figure 1


8/16

Financial Incentives and Deciency PatternsRecently, the National Quality Forum and theCenters for Medicare & Medicaid Services(CMS) have placed an increased focus onhospital-acquired pressure ulcers. Beginning

October 2008, CMS will discontinue thereimbursement of care for hospital-acquired

pressure ulcers. This includes cases that lackdocumentation of a pressure ulcer within 24hours of admission to the acute care facility.

In nursing homes, the number of healthcare

deciencies for pressure ulcer prevention andtreatment is increasing, with approximately onein ve nursing homes in Ohio cited for decientpractices between May 2007 and May 2008.Regulatory concerns aside, nursing homes inOhio also have a nancial incentive to reducethe number of pressure ulcers: if a facility hashealthcare deciencies, they receive less

Medicaid funding.

Whats the bottom line on pressure ulcers forhealthcare providers? With pressure ulcerslinked to reimbursement rates, consistent and

appropriate documentation of skin inspections,risk assessments and preventive interventions ismore important than ever.

IHI 5 Million Lives CampaignIn an effort to protect patients from medicalharm, the Institute for Healthcare Improvement(IHI) began the 5 Million Lives Campaign inDecember 2006. The 5 Million Lives Campaign


PREVENTING PRESSURE ULCERS IN THE

Pressure ulcers can cause signicant harm to patients. Not only are theypainful, but they can also impede functional recovery and lead to infectionor even death. Although pressure ulcers are preventable in most cases, theyare becoming more and more prevalent. According to a 2003 article in the

Journal of the American Medical Association, an estimated 2.5 millionpatients are treated for pressure ulcers in acute care facilities in this

country each year. JAMA further reports that incidence rates varyconsiderably by clinical setting, ranging from 0.4 percent to 38 percent inacute care; from 2.2 percent to 23.9 percent in long-term care; and from 0percent to 17 percent in home care.

Acute Care Setting



denes medical harm as unintended physicalinjury resulting from or contributed to bymedical care (including the absence of indicatedmedical treatment), that requires additionalmonitoring, treatment or hospitalization, or thatresults in death. Such injury is considered harmwhether or not it is considered preventable,resulted from a medical error, or occurredwithin a hospital.

Recognizing that many efforts have alreadybeen made by healthcare providers to preventpressure ulcers, the IHI has attempted touncover some of the reasons that this clinicalcondition remains a persistent matter. In a 2007article that appeared in The Joint Commission

Journal on Quality and Patient Safety, IHIFaculty Member Kathy Duncan noted, Foryears, healthcare organizations have tried toprevent pressure ulcers, but have lacked reliable

strategies as well as a long-term commitment toprioritize and design caregivers work so thatprevention remains a priority.

As outlined by the campaign, certain strategieshave proven effective in preventing pressureulcers. Implementing these changes throughoutan entire facility requires an organizationalcommitment and a standardized approach.

According to the IHI, pressure ulcer preventionentails two major steps: (1) identication ofpatients who are at risk and (2) reliable implementation of prevention strategies for all

patients who are identied as being at risk.

To identify patients at risk, the IHI recommendsthe following:

Conduct a pressure ulcer admissionassessment for all patients

Reassess risk for all patients daily

To implement prevention strategies, the IHIrecommends the following:

Inspect skin daily Manage moisture Optimize nutrition and hydration Minimize pressure

Leasa Novak, LPN, BA Quality Improvement Specialist,[email protected] and

Barbara Stiebling, RN, MSN, CPHQ Quality ImprovementSpecialist, [email protected]

The IHI 5 Million LivesCampaign considers thedevelopment of a pressure ulceras an incident of medical harm.

References

CASPER Report 0314S, Most Frequently Cited Tags, ChicagoRegional Ofce, 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. JA2003; 289(2):223-226.

Pressure Ulcer StatisticsNearly one million people develop pressure ulcers each year.

Approximately 60,000 acute care patients die from relatedcomplications.

The cost of treating a pressure ulcer is between $500 and $70,000 andincludes such things as treatment and dressing supplies, consults,staff time and labor.

The total cost for treatment nationally in the US is estimated at $11billion 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 syst ematic review. JAMA 2006;296:974-984

First StepsForming a multidisciplinary team to develop a pressure ulcerprevention program is an easy way to ensure long-term organizationalcommitment to preventing pressure ulcers. IHI makes the followingrecommendations:

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



Reconsidering Physical Restraint Use in the

Nursing Home

MPhysical restraints can have harmful effects onnursing home residents. As caregivers and

nursing professionals, it is imperative that wethoroughly understand the laws, risks, andalternatives pertaining to restraint use. TheLong-Term Care Resident AssessmentInstrument (RAI) Users Manual Version 2.0associates the following negative consequenceswith restraint use:

Strangulation Loss of muscle tone Decreased bone density (with greater

susceptibility for fractures) Pressure ulcers Decreased mobility Depression and agitation Loss of dignity Incontinence and constipation Death

Furthermore, indiscriminate use of restraints,such as for the convenience of the staff, notonly violates residents rights to freedom anddignity, but has also been associated with higherrates of injury and injuries associated with falls,precisely the conditions that the restraints areintended to prevent.

Do physical restraints help reduce falls?No. The routine use of restraints does not lower

the risk of falls or fall injuries. They can actuallyadd to the risk of fall-related injuries anddeaths. 4 Thus, they should not be used as a fallprevention strategy. 5

Furthermore, limiting a patients freedom tomove around leads to muscle weakness andreduces physical function. 6

Since federal regulations took effect in 1990,nursing homes have reduced the use of physicalrestraints. 7 Some nursing homes have reportedan increase in falls since the regulations tookeffect, but most have seen a drop in fall-relatedinjuries. 8

Leasa Novak, LPN, BA,Quality Improvement Specialist, [email protected] and

Deborah Shaeffer, LPN,Quality Improvement Specialist, [email protected]

More than 108,000 nursing home residents are physically restrained in theUnited States every day. 1 Research and standards of practice show that thebelief that restraints ensure safety is often unfounded. In practice, restraintshave many negative side effects and risks that in some cases far outweighany possible benet that can be derived from their use. 2 In fact, as many as200 deaths occur every year as a result of strangulation or suffocation fromrestraints, even when they are applied according to manufacturersinstructions. 3

1 CDC. Health, United States, 2004.http://www.cdc.gov/nchs/data/hus/hus06.pdf, last accessed 8/27/08.

2 CMS RAI Version 2.0 Manual AppeC, Page C-99.

3 Guttman R, Altman RD, Karlan MSReport of the Council on ScienticAffairs. Use of Restraints for Patienin Nursing Homes. Council onScientic Affairs, American MedicaAssociation. Archives of Family Me1999; 8(2): 101-5.

4 Rubenstein LZ, Josephson KR,Robbins AS. Falls in the nursinghome. Annals of Internal Medicine1994;121:44251.

5 Capezuti E, Evans L, Strumpf N.Physical restraint use and falls innursing home residents. Journal of

American Geriatrics Society1996;44:62733

6 Rubenstein LZ. Preventing falls in nursing home. Journal of the AmerMedical Association1997;278(7):5956.

7 Rubenstein et al. 19948 Ejaz FK, Jones JA, Rose MS. Falls

among nursing home residents: anexamination of incident reports befoand after restraint reduction program

Journal of the American Geriatrics S1994;42(9):9604.


11/16 A NEWSLETTER ABOUT HEALTHCARE QUALITY IMPROVEMENT 1

MEDICARE TO REFUSE

PAYMENT FOR PREVENTABLEOCCURRENCES IN OCTOBER WITH

MORE TO FOLLOW

1. Object left in surgery2. Air embolism3. Blood incompatibility4. Catheter-associated urinary tract infections5. Pressure ulcers (decubitus ulcers)6. Vascular catheter-associated infection7. Surgical site infection mediastinitis after

coronary artery bypass graft surgery

8. Hospital-acquired injuries fractures,dislocations, intracranial injury, crushinginjury, burns, and other causes.

These serious preventable events or neverevents are derived from the National QualityForums (NQF) list of 28 inexcusable outcomes ina healthcare setting. The NQF denes neverevents as serious, largely preventable, and ofconcern to both the public and healthcareproviders for the purpose of publicaccountability.

This change in Medicare reimbursement wasinitiated in an October 2007 revision of theDecit Reduction Act of 2005.

Beginning in October 2008, the Centers for Medicare & Medicaid Services(CMS) will refuse hospital reimbursement for additional costs associatedwith eight conditions or events, unless they were present on admission,including:



12/16

These non-reimburseable conditions mark thebeginning of a new trend in the Medicare/

Medicaid system to cut costs. When this newpayment rule was nalized in July 2008, CMSalso sent a letter to state Medicaid directorsproviding information about how states canadopt the same never events practices. Nearly 20states already have or are considering methodsto eliminate payment for some never events.

In 2009, the following three events are plannedto be added to the non-payment list:

1. Surgical site infections following certainelective procedures, including certainorthopedic surgeries and bariatric surgery forobesity

2. Certain manifestations of poor control of bloodsugar levels

3. Deep vein thrombosis of pulmonary embolismfollowing total knee replacement and hipreplacement procedures.

Again, these occurrences will not be reimbursedunless the medical record shows that they werepresent upon admission.

At the same time, CMS is also in the process ofdeveloping three National CoverageDeterminations (NCDs) that would address

Medicare coverage of certain surgical proceduresand set national policy on whether Medicare willcover an item of service and under whatconditions. In the absence of an NCD, coveragedecisions are made by local contractors thatprocess and pay Medicare claims. The threetypes of surgery under consideration are surgeryon the wrong body part, surgery on the wrongpatient, and wrong surgery occurrences. The

Medicare NCD program is slated to begin in2009.

Evaluating coverage of these procedures andrefusing payment for preventable occurrences are yet two more important steps for Medicare inaddressing concerns regarding never events.

Susan Ferrante, AQuality Improvement Specialist, [email protected]


FROM PAGE 13


13/16



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15/16 A NEWSLETTER ABOUT HEALTHCAR E QUALITY IMPROVEMENT 15

Notices of non-coverage are now given routinely in all inpatient and some outpatientsettings. A list of these notices follows:

Notice Who? When? Notes

Important Message Hospitals including No greater than Regardless if patient isfrom Medicare long-term acute care two days prior to enrolled in a Medicare discharge traditional fee for

service or MedicareAdvantage plan

Benets Improvement and Skilled nursing facilities, Two days prior to Not given for aProtection Act (BIPA) home health agencies, discharge/skilled reduction in serviceNotice and Medicare hospices, and comprehensive services ending (or Advantage (MA) Notice outpatient rehabilitation two visits prior to For Medicare facilities the last visit) Advantage, the plan generally makes the

decision, but it is thefacilitys or agencysresponsibility to deliverthe notices

Detailed notice All When an appealis 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 formandatory use of the updated forms. Mandatory use of the updated forms will begin on November 1, 2008.

Jennifer Bitterman, MBA, RReview Director, [email protected]

REQUIRED MEDICARE NOTICES OF NON-COVERAGE

AT A GLANCE


16/16

Rock Run Center, Suite 1005700 Lombardo Center DriveSeven Hills, OH 44131

All material presented or referenced herein is intendedfor general informational purposes and is not intendedto provide or replace the independent judgment ofa qualied healthcare provider treating a par ticularpatient. Ohio KePRO disclaims any representation orwarranty with respect to any treatments or course oftreatment based upon information provided.

Publication No. 900100-OH-025-9/2008. This materialwas prepared by Ohio KePRO, the Medicare QualityImprovement Organization for Ohio, under contractwith the Centers for Medicare & Medicaid Services

(CMS), an agency of the U.S. Department of Healthand Human Services. The contents presented do notnecessarily reect CMS policy.

TELL US

What you thinkThis is the rst 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 [email protected]

SUBSCRIBE TO OUR E-NEWSLETTERS Spotlight on Quality Quarterly newsletter providing news, events and best

practices in Ohio healthcare Information Updates Receive timely noti cations on available Ohio KePRO

educational and training opportunities, industry regulatory updates and otherimportant news

To subscribe, go to www.ohiokepro.com/subscribe.

To be removed from our printed newsletter mailing list, please send an e-mail [email protected] with Remove from Mailing List in the subject line. Pleaseinclude your name, address, and place of employment (if applicable). You may also fax

QUALITY S P O T L I G H T

FALL 2008 y V O L . 6 N O . 4 y WWW.OHIOKEPRO.COM

O N

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 2

TAPPING INTO YOUR ELECTRONIC HEALTHRECORDS FULL POTENTIAL 3

REGULATORY UPDATE 5

GOING NOWHERE WITH RESTRAINTS 6

TEN WAYS TO BEAT THE MRSA SUPERBUG 7

PREVENTING PRESSURE ULCERS IN THEACUTE CARE SETTING 8

RECONSIDERING PHYSICAL RESTRAINT USEIN THE NURSING HOME 10

MEDICARE TO REFUSE PAYMENT FOR PREVENTABLEOCCURRENCES IN OCTOBER WITH MORE TO FOLLOW 11

CALENDAR/REMINDERS 13

DRUGS TO AVOID WITH ELDERLY PATIENTS 14

REQUIRED MEDICARE NOTICES OFNON-COVERAGE AT A GLANCE 15

Documents

Nwewsletter Spotlight Fall 2008