On behalf of all of us at Acumentra Health, I wish you good health and abundance in the year ahead. 2009 will be a year of opportunities as we continue our work with many of you to improve the quality and safety of patient care. To name a few of our many ongoing initiatives:

• Supporting surgical care–heart failure care improvement projects in Oregon hospitals
• Fostering exchange of best practices among Oregon hospitals preparing to report MRSA data to the CDC’s Multiple Drug Resistant Organism (MDRO) database
• Helping hospitals and nursing homes work together to prevent pressure ulcers in patients with Medicare and assisting nursing homes in reducing use of restraints
• Leading Washington State Collaborative educational tracks on child health topics
• Delivering structured feedback to health plans that provide physical and mental health services to Medicaid enrollees, in our role as External Quality Review Organization for Oregon and Washington
• Guiding medical practices in using electronic health record systems to improve preventive care and to report quality data
• Performing utilization review for the Oregon Health Plan
• Protecting the rights of Oregon Medicare beneficiaries through mandatory review of complaints or appealed discharge notices
• Assisting hospitals in submitting validated patient records to CMS for the Annual Payment Update

We invite you to visit our website for a detailed account of accomplishments in our work together.

It has been an honor and a pleasure to collaborate with so many dedicated healthcare leaders and quality professionals during 2008, and we look forward to continuing our alliance going forward. Best wishes for your continuing success.

New officers and trustees

Acumentra Health installed a new slate of officers at the January 12 meeting of its Board of Trustees. We’re fortunate to be able to tap their diverse expertise for guidance in meeting the challenges of healthcare quality improvement.

Our new board chair is Brian Gard, president of Gard Communications, a corporate and public policy, advertising and public relations firm based in Portland. A member of Acumentra Health’s board since 2005, he also serves on the boards of the Oregon Business Association and Willamette University.

Shelley Barnes, NHA, our new vice chair (chair-elect), is a consultant with Oregon Health & Science University’s Child Development and Rehabilitation Center, where she works with families who have children with autism. Ms. Barnes also has administered several nursing home facilities. She serves on the board of Albertina Kerr Centers.

Joy Conklin, the incoming secretary/treasurer, is director of socioeconomic affairs for the Oregon Medical Association. She participates in many professional organizations, including the Oregon Healthcare Workforce Institute Advisory Council, the Medicare Carrier Advisory Committee, and the American Medical Association’s Private Sector Advocacy Committee.

Acumentra Health also seated several trustees elected by our physician members to continue in service following interim appointments to the board. To view the full roster of board members and their biographies, please visit www.acumentra.org/corporate/board.php.

Acumentra Health reports on Washington’s Medicaid managed care program

As the External Quality Review Organization for Washington’s Health and Recovery Services Administration (HRSA), Acumentra Health has delivered the 2008 EQR Annual Report, evaluating the health care provided through the state’s managed care programs for Medicaid enrollees.

Previous annual reports from 2005 through 2007 focused on physical healthcare services delivered by medical managed care organizations (MCOs). The 2008 annual report is the first to incorporate a review of mental healthcare services delivered by the state’s Regional Support Networks (RSNs). The new report structure reflects Washington’s long-term goal of integrating the delivery of physical and mental health services.

To evaluate the services delivered by the MCOs and RSNs, Acumentra Health analyzed data on a variety of performance measures, such as the Healthcare Effectiveness Data and Information Set (HEDIS®*) measures, and assessed the health plans’ compliance with state and federal regulatory and contractual standards.

The report notes high-level strengths of HRSA and the managed care program, and recommends numerous measures aimed at further improving the quality of Medicaid managed care services.

To view the report, please visit http://maa.dshs.wa.gov/healthyoptions/newho/reports/reports.htm

* HEDIS is a registered trademark of the National Committee for Quality Assurance.

CMS validation achievement: Sky Lakes Medical Center

Acumentra Health commends Sky Lakes Medical Center, Klamath Falls, Oregon, for achieving a 100 percent score on validation of medical records submitted for Medicare quality assurance and reporting. Sky Lakes Medical Center was the only Oregon hospital to score 100 percent for data on patients discharged in 1st quarter 2008 (the most recent measurement period).

The validation is part of a process that qualifies hospitals to receive full payment from Medicare (called the Annual Payment Update, or APU). The 33 Oregon hospitals participating in Medicare’s Prospective Payment System must meet specific data reporting and validation criteria:

• Collect and report data on 30 quality measures, covering care for heart attacks, heart failure, and pneumonia; surgical care improvement; 30-day mortality rates following heart attack, heart failure, and pneumonia hospitalizations; and patients’ experience of care
• Pass a quarterly audit of sample medical records (to validate that care reported in the records supports the reported data); hospitals must achieve an overall score of at least 80 on records from a period designated by federal regulations
• Agree to display the results of their quality measure data on Hospital Compare (www.hospitalcompare.hhs.gov) for public viewing

Acumentra Health commends Sky Lakes Medical Center for the diligence and accuracy represented by this achievement.

Q-News, Issue 17
© 2009 Acumentra Health. All rights reserved.

This material was prepared in part by Acumentra Health, Oregon’s Medicare Quality Improvement Organization, 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.
GEN-OR-GEN-09-01
1/26/09