Ohio KePRO Motion June 2004

Under the Medicare Prescription Drug,
Improvement and Modernization Act of
2003 (MMA), beginning in 2005 all newly
enrolled Medicare beneficiaries will be
covered for an initial physical examination.
In addition, all beneficiaries will be covered
for cardiovascular screening blood tests,
and those considered to be at risk will be
covered for a diabetes screening test.

Welcome to Medicare Physical The initial
preventive physical exam includes baseline
measurement of height, weight, and blood
pressure, an electrocardiogram, and
education, counseling and referral related to
other Medicare-covered preventive ser vices,
such as vaccinations, screening mammography,
and prostate cancer screening.

Cardiovascular Screening This benefit
provides a blood test for the early detection
or elevated risk of cardiovascular disease
by testing cholesterol levels and other lipid
or triglyceride levels. There is no deductible
or copayment for the test, so beneficiaries
do not incur any cost.

Breathing Easier:
Ohio KePRO Forges New
National Partnership in
Respiratory Care
A

"Respirator y therapists are ver y strong
allies in the fight against cigarette
use," Dr. Sopko said. "But no one had
really put this thing together."

par tnership between Ohio KePRO,
the state Quality Improvement
Organization, and respirator y therapists
has yielded dramatic increases in
smoking cessation counseling rates
for hospitalized patients, including
one hospital whose rates increased
from the teens to the 90s within a
few months.

Sam Giordano, CEO of the American
Association for Respirator y Care
(AARC), echoed Dr. Sopko's thoughts.

"We see the damage that smoking
causes ever y day and much of it is
avoidable. We need to not just treat
the disease, but we also have to
engage in behavioral changes that
cause the disease," Giordano said.

Ohio KePRO Medical Director Margaret
M. Toth, MD, said she hopes the success
in Ohio and the enthusiasm met by the
respirator y care community, as well as
the American Hear t Association, will
drive national effor ts to increase the
number of patients receiving smoking
cessation counseling.

He also noted that patients experiencing
a breathing problem are more inclined
to listen to smoking cessation counseling.

"This par tnership has brought us in
contact with a group in a hospital who
we have not traditionally reached out
to, and provides a way for us to give
the quality improvement people we
work with a new way of thinking about
how to implement improvement and
get them to move outside of their
sphere," Dr. Toth said. "Respirator y
therapists are a great resource for
quality improvement."

"There's a bit of a panic that people
go through when they experience
breathing difficulties, and it ser ves as
a terrific wake-up call," Giordano said.

Ohio KePRO launched its pilot in
Januar y with a handful of hospitals.
Dr. Toth said respirator y therapists met
the par tnership with great enthusiasm.

Diabetes Screening This new benefit
includes a fasting plasma glucose test to
identify and treat beneficiaries at risk for
diabetes. An estimated 5 million Americans
had undiagnosed diabetes in 2002. Medicare's
growing package of covered health screenings
offers health practitioners the oppor tunity
to emphasize preventive strategies with the
Medicare beneficiaries they treat.

For the latest information about Medicare,
visit www.medicare.gov or call
1-800-MEDICARE (1-800-633-4227).
TTY users should call 1-877-486-2048. I

Dr. Toth said Ohio KePRO decided to
tr y the par tnership after brainstorming
last October with its pulmonar y
consultant, Joseph Sopko, MD, who
is also the director of the Depar tment
of Medicine at St. Vincent Charity
Hospital in Cleveland and ser ves as a
Governor's appointee to a board on
tobacco use and prevention. He said
respirator y therapists and smoking
cessation counseling is an ideal match
because they are a small, specialized
group within the hospital setting.

"The next question was, would the
respirator y therapists want to do that?
And they were incredibly eager at the
local and national levels to take this
on," she said.

In a recent conference call, Craig
Myers, RRT, PA-C, RN, manager of
respirator y therapy at St. Vincent, said
his hospital developed a system that
incorporated an existing computerized
physician order entr y system. Nurses
asked any patients admitted for
breathing problems if they smoked,
and smokers were asked if they would

By Karen Gallagher, RN
Outreach Intervention Specialist, Ohio KePRO

My coworkers and I have been talking about
the many barriers that can prevent seniors
from getting necessar y healthcare. The
most obvious barriers are a lack of
transpor tation, bad weather, and a different
doctor for ever y body par t, increasing the
number of doctor visits and the problems
that may result.

The fact of multiple doctors can cause
another challenge: shared communication
about your health. Are your lab test and
examination results properly forwarded to
ever yone involved with your healthcare? If
they were not, would you know? Are the
medications Dr. A ordered safe to take
with the medications Dr. B ordered last
month? Don't take chances with your health.
You need to be in control.

There are different ways to organize and
document one's own healthcare. Some
people are comfor table using computers
and can electronically record their health
information. The point is to have your health
information readily available to best manage
your healthcare.

Think of it this way. If you couldn't speak,
if you couldn't answer any questions about
yourself, you would still need to be able to
communicate a complete picture of your
health. For example, what if you were
unconscious and taken to an emergency
room, alone. Would the doctor know you are
taking aspirin daily, and so may choose to
not use a blood thinner? Would he know
you have a histor y of seizures?

The point is: your treatment will change
according to your health histor y.

Your health facts need to be ready to share.
What health information do you need to write
down? Your family medical histor y is ver y
important. All medications and their frequency
and dosage need to be listed, and all
vaccinations received and the date given.
The results of lab tests and examinations
are also ver y impor tant.

Ohio KePRO offers a FREE Senior Health
record (wallet size) and a Senior Health
guide (pocket size). They provide a way to
record your health histor y, vaccinations, test
and examination results. They also allow
space for your personal information, doctors
information, and emergency contacts. Request
this educational and record-keeping booklet
today and take charge of your health. Call
Ohio KePRO's Medicare Beneficiary Help Line
at 1-800-589-7337 or visit our Web site at
www.ohiokepro.com and place an order.

Karen Gallagher is the Outreach Inter vention Specialist
for Ohio KePRO, Ohio's Medicare Quality Improvement
Organization. Karen has 30 years of experience in
patient care and travels throughout Ohio to speak on
health care topics such as diabetes, breast cancer,
immunization, and beneficiar y rights under Medicare.
To request a free presentation for your group, contact
the Ohio KePRO Medicare Beneficiar y Help Line at
1-800-589-7337. I

Breathing Easier (cont.)

like counseling on smoking cessation.
Nurses then put the counseling request
into the hospital system, which flagged the
pulmonar y depar tment for counseling.

The counseling included materials such
as a pamphlet with 20 tips on how to quit
smoking, and a television program on smoking
cessation that runs 24 hours a day on the
hospital system.

Within months, counseling rates for smok-
ing cessation went from 15-20% to more
than 90%.

Another par ticipating hospital, Fisher-Titus
Medical Center, developed an interactive
Web site, www.fisher-titus.com/stopsmoking,
with message boards, a nicotine dependency
test, and tracking status capabilities to aid
smokers in their effor ts to quit.

"What we're tr ying to do is saturate the
state with this concept and we're finding
that all of us have different venues to do
that," Dr. Toth said.

Due to the success of the pilot projects,
Ohio KePRO contacted staff at the Ohio
Respirator y Care Association, who embraced
the par tnership and invited representatives
of the national association as well as the
American Hear t Association to par ticipate.

"It's moving with lightning speed. The par t-
nerships don't always take a long time if
there's energy," Dr. Toth said.

"We're ver y grateful that Ohio KePRO
offered to be the catalyst," Giordano said.
"It's long overdue." I

Executive Editor : Suzana C. Iveljic, MBA

Editor : Daniel B. Moss, BSBA

e-mail: dmoss@ohqio.sdps.org

T H E J U N E E D I T I O N O F O H I O Ke P RO M O T I O N H A S A R R I V E D !
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Publication No. 4123-OH-009-6/2004. This material was prepared by Ohio KePRO under a contract with the Centers for Medicare & Medicaid Ser vices (CMS),
an agency of the U.S. Depar tment of Health and Human Ser vices (DHHS). The contents presented do not necessarily reflect CMS policy. For more information,
please call 1-800-MEDICARE (1-800-633-4227), or visit the CMS Web site at www.medicare.gov.