TIP OF THE WEEK
Five clues that a person with dementia is in pain
- Facial ExpressionsDoes the person frown, look frightened, grimace, wrinkle his or her brow, keep eyes closed tightly, blink rapidly, or exhibit any distorted expression?
- Verbalizations/VocalizationsDoes he or she moan, groan, sigh, grunt/chant/call out, breathe noisily, ask for help, or become verbally abusive?
- Body MovementsIs the person’s body posture rigid and/or tense? Does he or she fidget, pace or rock back and forth, have restricted movement, gait or mobility changes?
- Behavioral ChangesDoes he or she refuse food or have an appetite change? Is there any change in sleep/rest periods? Has he or she suddenly stopped common routines or begun wandering?
- Mental Status ChangesDoes he or she cry, become more confused, irritable or distressed?
RESOURCE SPOTLIGHT
Assessing Pain In Loved Ones With Dementia
From the Improving Pain Interfering with Activity Tools and Resources provided by Delmarva, this Assessing Pain In Loved Ones With Dementia brochure is provided by the AGS Foundation for Health in Aging.
Have you completed the Home Health Immunization Survey for 2007?
Please take five minutes to complete the 36 survey questions relating to your immunization practices. We are re-measuring the immunization practices in Ohio home health agencies and we need your help. The results of this survey will be compared with last year’s survey to identify trends over time.
MEMORANDUM OF AGREEMENT
Ohio KePRO is the Quality Improvement Organization (QIO) authorized by the Medicare program to review medical services provided to Medicare beneficiaries in Ohio. As you may know, we review medical records to determine whether services delivered to these beneficiaries meet medically acceptable standards of care, are medically necessary, and are delivered in the most appropriate setting. In addition, we review written complaints from Medicare beneficiaries about the quality of Medicare services they have received and conduct quality improvement projects to make measurable improvements in beneficiary health status or satisfaction.
In order to participate in the Medicare program, certain providers are required under federal law to have a Memorandum of Agreement (MOA) with a QIO. Medicare Advantage Organizations (MAs) must have a MOA with a QIO or an independent quality review organization. MOAs outline the QIO’s and provider’s responsibilities during the review process. MOAs are also intended to be informational.
Section 1866 (a)(1)(E) of the Social Security Act requires providers of services to have an agreement with QIOs to release data related to patients when a QIO requests it.
Section 1866 (a)(1)(F)(i) of the Social Security Act requires hospitals which provide inpatient hospital services paid under the Prospective Payment System (PPS) to maintain an agreement with QIOs to review the validity of diagnostic information provided by such hospitals, the completeness, adequacy and quality of care provided, the appropriateness of admissions and discharges, and the appropriateness of care provided for which additional payments are sought.
Section 1866 (a)(1)(F)(ii) of the Social Security Act requires hospitals, critical access hospitals (CAHs), skilled nursing facilities (SNFs), hospices, LTACs, CORFs and home health agencies (HHAs) to maintain an agreement with a QIO to perform certain functions.
The MOA describes (a) Ohio KePRO procedures with respect to certain contract obligations, (b) review and appeal rights providers have with respect to these obligations, and (c) opportunities providers have to partner with Ohio KePRO in local and national quality improvement projects.
Ohio KePRO has sent out two previous requests for MOAs. Ohio KePRO is most appreciative of those who have signed and returned their MOAs to us. If you have not signed and returned your MOA to Ohio KePRO, it is imperative that you do so immediately. If you require another copy of the MOA or have any questions, please contact Linda Greel at 216-447-9604, ext. 2102 or via e-mail at lgreel@ohqio.sdps.org.
IN THE NEWS
April 17, 2007 -- HHQI National Campaign -- Later this month, registered Home Health Quality Initiative (HHQI) participants will receive their second HHQI Campaign Benchmarking Report. Many home health agencies have questions about these reports and how they can use them.
The first page of the report contains a wealth of information, including each agency's ACTUAL acute care hospitalization rate and RISK-ADJUSTED acute care hospitalization rate. Understanding the difference between these rates can be difficult.
The actual rate simply shows you what really happened in your agency, while the risk-adjusted rate shows you how your agency performed after adjusting for your case mix. The actual rate is what your agency can see (via the OBQI Reports), while the risk-adjusted rate is what everyone else can see (via Home Health Compare).
It is not necessarily better (or worse) if your risk-adjusted rate is higher (or lower) than your actual rate. Rather, you want to see BOTH of these rates improve throughout the HHQI Campaign, because any improvements in your actual rate will improve your risk-adjusted rate as well.
More information and FAQs >>
OHIO, MICHIGAN RATE AVERAGE IN MOST MEDICAID AREAS
April 19, 2007 -- Toledo Blade -- For quality of health care, Ohio’s Medicaid program ranks the third highest among all states nationwide, according to a report released yesterday. Yet Ohio’s health insurance program for needy residents was ranked No. 29 overall nationwide after falling below average on the report’s three other categories: eligibility requirements, covered services, and reimbursements to providers. Read more >>
WESTAT TO SURVEY OHIO PROVIDERS THIS SPRING/SUMMER
The Centers for Medicare & Medicaid Services (CMS) has contracted with Westat to survey a sample of Ohio healthcare providers about Ohio KePRO, the Medicare Quality Improvement Organization (QIO) for Ohio. If contacted, please take the opportunity to complete this voluntary, confidential survey online or by phone and help shape the future of healthcare quality improvement in Ohio.
HUMANIZING DEMENTIA CARE MAY EXTEND PATIENTS’ LIVES
April 24, 2007 -- Newswire -- Through an intensive comparative study of two nursing home units using contrasting approaches to dementia care for elders with severely disturbed behaviors, Central Michigan University professor of anthropology Athena McLean has found that "humanizing" approaches to dementia care may not only extend quality of life for patients, but also their length of life. Read more >>
RESPITE CARE BENEFITS UNPROVEN DESPITE HIGH DEMAND
April 24, 2007 -- Newswire -- Family members and friends often need support as they cope with being the main caregivers for their older, sick or disabled loved ones. One source of such support is respite care, but there is no clear proof that it benefits those who use it, according to a new review from England. Read more >>
COMING ATTRACTIONS
May 1, 2007, 3:00 p.m. to 4:00 p.m. Speaker: Dr. Elizabeth Madigan.
1-800-862-9098 ID: KePRO
ARE YOU READY FOR PAY-FOR-PERFORMANCE?
A half-day seminar in Lima on May 2, 2007.
9:00 a.m. to 12:00 p.m. or 1:00 p.m. to 4:00 p.m.
Download the flyer and Register online
