Q-News, January 2010: Pressure ulcer toolkit, Washington Medicaid EQR annual report, hospital validation



Greetings for 2010 from Jon K. Mitchell, FACHE, president and CEO Every challenging time provides seeds of opportunity for making things better. As the economy continues to struggle and our legislators determine the outcome of national healthcare reform legislation, we have been working steadily with many of you to put in place innovations that promise to make health care safer, more effective, and more affordable. During 2009, Acumentra Health staff engaged in the following quality improvement-related activities: Coordinated the collaborative development of a Transitional Care & Pressure Ulcers Project Toolkit, incorporating best practices from experts in multiple care settings. The tools are used by nursing homes and hospitals in our Medicare-funded work Guided medical practices in using electronic health record systems to report quality data and improve preventive care processes Delivered structured feedback to help managed care plans improve the quality of physical and mental health services for Medicaid enrollees, in our role as External Quality Review Organization for Oregon and Washington Researched and developed a multi-audience Colorectal Cancer Screening Toolkit on behalf of Oregon Department of Human Services Concluded fruitful group-learning activities for local clinics on child health topics, as part of the Washington State Collaborative to Improve Health Helped a group of Oregon nursing homes reduce the use of restraints Supported surgical care–heart failure care improvement projects in Oregon hospitals Helped Oregon hospitals begin to report MRSA data to the CDC’s Multiple Drug Resistant Organism database Performed utilization review of physical and mental health services for the Oregon Health Plan Protected the rights of Oregon Medicare beneficiaries through mandatory review of complaints or appealed discharge notices Assisted hospitals in submitting validated patient records to CMS for the Annual Payment Update We invite you to visit our website to learn more about these projects. It was an honor to collaborate with so many dedicated healthcare leaders and quality professionals during 2009, and we look forward to continuing our partnerships in the new year. New toolkit promotes pressure ulcer prevention in transitions between care settings A new Transitional Care & Pressure Ulcers Project Toolkit aims to reduce the toll of pressure ulcers by disseminating best practices specific to individual clinical settings and providing a “handoff dataset” form for sharing critical information between settings. The outcome of 18 months of work by the Advancing Excellence and Oregon IHI Network Joint Committee and its advisory panel of clinicians, educators, health plan representatives, and experts from regulatory and quality improvement agencies, the toolkit offers practical information for healthcare professionals about reducing the prevalence of pressure ulcers. Acumentra Health is a member of the Joint Committee as well as of Advancing Excellence (a nursing home quality campaign) and the Oregon IHI Network, and is hosting the toolkit on its website. “Pressure ulcers are a painful and expensive patient condition,” says Stacy Moritz, RN, MBA, director of Medicare Quality Services at Acumentra Health. “Our intent with the toolkit is to provide accessible models for effective preventive care and treatment, and for clearly communicating key information during transitions. These tools can support each setting in delivering the best possible care and in sharing information as patients leave their care.” To download the best practices, handoff dataset, and other tools, visit www.acumentra.org/PU. Acumentra Health reports on status of Washington Medicaid program As the External Quality Review Organization for Washington’s Health and Recovery Services Administration (HRSA), Acumentra Health has delivered the 2009 annual report evaluating the health care provided through the state’s managed care programs for Medicaid enrollees. The 2009 annual report builds on the findings of previous annual reports since 2005. The 2008 report was the first to integrate a review of the mental health services delivered by the state’s Regional Support Networks, in addition to physical health services delivered by other managed care organizations. The report’s approach reflects HRSA’s goal of further integrating medical assistance, mental health services, and chemical dependency treatment, with statewide implementation of a health home model. HRSA reorganized its administrative functions during 2009 to facilitate working toward that goal. Acumentra Health analyzed data on a variety of performance measures and assessed the health plans’ compliance with state and federal regulatory and contractual standards. The analysis identifies many strengths and opportunities for improving quality in the Medicaid program, and offers detailed recommendations for action on the part of HRSA and the managed care plans. View the 2009 annual report (PDF) Oregon hospitals achieve 100 percent Medicare validation Acumentra Health recognizes three Oregon hospitals for achieving a 100 percent score on validation of medical records submitted for Medicare quality assurance and reporting for 1st quarter 2009: Legacy Good Samaritan Medical Center, Portland Legacy Meridian Park Medical Center, Tualatin Three Rivers Community Hospital, Grants Pass Legacy Meridian Park also had 100 percent validation for 4th quarter 2008. 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: Reporting: Collect and report data on 44 quality measures, covering care for heart attacks, heart failure, and pneumonia; surgical care improvement; 30-day mortality and readmission rates following heart attack, heart failure, and pneumonia hospitalizations; and patients' experience of care Audit and validation: 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 percent on records from a period designated by federal regulations Publication: Agree to display the results of their quality measure data on Hospital Compare for public viewing (http://www.hospitalcompare.hhs.gov) Acumentra Health commends these hospitals for the diligence and accuracy represented by this achievement.	In This Issue: Greetings for 2010 New toolkit promotes pressure ulcer prevention in transitions between care settings Acumentra Health reports on status of Washington Medicaid program Oregon hospitals achieve 100 percent Medicare validation www.acumentra.org 2020 SW Fourth Avenue, Suite 520 Portland, Oregon 97201-4960 Phone: 503-279-0100 Fax: 503-279-0190 Communications@acumentra.org January is National Blood Donor Month Did you know: Blood supplies are typically lowest during the winter months. Every two minutes, someone in the United States needs a transfusion, and one blood donation can help save the lives of up to 3 people. Although 38% of the population is eligible, only about 3 in every 100 people actually donates blood. To find a drive or donation center near you, visit www.redcrossblood.org/pnw.
Q-News, Issue 21 © 2010 Acumentra Health. All rights reserved. This material was prepared 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. 9SOW-OR-GEN-10-01 1/20/10