Ohio KePRO: Quality Matters Newsletter
Vol. 5 No. 3 :: Fall 2007 ::   

 

Surgical Care Improvement Project (SCIP): A Partnership for Better Surgical Care in Ohio Hospitals

 

By Susan Ferrante, ARM, Quality Improvement Project Leader

 

The multi-year national Surgical Care Improvement Project (SCIP) campaign and partnership began in August 2005 with a goal to substantially reduce surgical mortality and morbidity through collaborative efforts. Specifically, the goal is to reduce the incidence of surgical complications by 25 percent nationally by the year 2010. The SCIP national partnership of organizations is committed to improving patient safety by reducing postoperative complications. Initiated in 2002 by the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC), the then Surgical Infection Prevention Project (SIPP), now SCIP partnership, is coordinated through a National SCIP Steering Committee consisting of 10 organizations. An additional 20 or more organizations provide expertise to the Steering Committee through a Technical Expert Panel.

 

Strong commitment to patient safety

Now just two years after the SCIP campaign and partnership began, the accomplishments of the Ohio SCIP Identified Participant Group (IPG) hospitals reflect a strong commitment to patient safety. Hospital staff and physicians work in safety-critical settings providing technically challenging and hazardous modalities of medical care to patients. Healthcare, by definition and characteristics, places emphasis on human factors and systems-oriented approaches to organizational patient safety. Healthcare institutions that strive to be High Reliability Organizations (HROs) recognize that they must be attentive to individual players where each sees the impact of his or her performance on the care delivered to the patient as well as to the rest of the organization. The efforts of Ohio’s SCIP IPG hospitals demonstrate their commitment to function as HROs and the importance of delivering the right care to patients every time.

 

The collaboration of the SCIP IPG hospitals has been energetic and focused. Ohio KePRO has worked intensively with 22 acute care hospitals to assist them in the implementation and sustainability of SCIP initiatives and adoption of standard processes of care.

 

The statistics quoted within this article are based on First Quarter 2007 data that were submitted by providers to the Clinical Data Warehouse. Further, as a point of clarification, hospitals in the SCIP IPG began collecting measures at different points in time. The Ohio SCIP IPG baseline compliance was calculated using either the first quarter reported by a hospital or the Quarter 1, 2005 measures data. As a point of clarification the statistics in this article do not include the SCIP-Cardiology 2 (Surgery patients on a beta blocker prior to arrival that received a beta blocker during the perioperative period) measure. The mean Ohio SCIP IPG hospitals’ baseline score, reflecting compliance with the measures in Quarter 1, 2005 was 81.32 percent. The target for improvement was a 25 percent reduction in failure rate, (RFR) or 85.99 percent.

 

Multi-state initiative

Ohio’s SCIP IPG hospitals also participated in a multi-state (Indiana, Illinois, Kentucky, Michigan, Ohio and Wisconsin) SCIP6 initiative. The IPG hospitals continue to work on the antimicrobial prophylaxis and expanded postoperative complications measure compliance targeting areas where the incidence and cost of surgical complications are high. These areas are cardiovascular (CV) complications such as acute myocardial infarction (AMI) and venous thromboembolism (VTE) complications such as pulmonary embolism. Ohio SCIP6 hospitals voluntarily reported SCIP infection measures for hair removal, glucose control and normothermia for Quarter 1, 2006 through Quarter 1, 2007. (See the accompanying graph for the measures compliance rate.)

 

 

 

SCIP Infection 1: Prophylactic Antibiotic Received Within 1 Hour Prior to Incision (or 2 hours if vancomycin or a fluoroquinolone is used for prophylaxis)

To assist with the goal of selecting a safe, cost-effective, broad-spectrum prophylactic antibiotic appropriate for most of the probable intra-operative contaminants for a specific operative procedure, the SCIP Steering Committee provided hospitals and physicians with a prophylactic antibiotic regimen selection for surgery based on the combined published recommendations of the American Society of Health System Pharmacists, the Medical Letter, the Infectious Diseases Society of America, the Sandford Guide to Antimicrobial Therapy and the Surgical Infection Society. Updates to the Antibiotic Selection Table for October 2007 discharges forward are available in the Specifications Manual on Quality Net (QNet) Exchange.

 

Additional strategies include, but are not limited to:

  • Designating responsibility and accountability for preoperative prophylactic antibiotic (e.g., preoperative nurse, anesthesia) along with standardizing the antibiotic process to occur one hour prior to incision
  • Provision of a standardized checklist along with a method of systematic documentation of antibiotic administration
  • Provision of preprinted physician order forms to standardize antibiotic selection per surgical category
  • Standardized hospital formulary to ensure appropriate antibiotic selection
  • Provision of a stock supply in the operating room of recommended prophylactic antibiotics in standard doses.

 

SCIP Infection 3: Prophylactic Antibiotics Discontinued Within 24 hours After Surgery End Time (48 Hours for Cardiac Patients)

 

Strategies to improve measure performance included:

  • Adoption of a “One Dose Prophylaxis” (ODP) protocol

  • Process changes: For example, the use of a checklist on the medical record to capture type, dose, route and time of prophylactic antibiotic, which permits clear documentation for calculating discontinuation of antibiotics within the proper timeframe

  • Use of preprinted orders from each surgical specialty for all procedures in which prophylaxis is appropriate, with an automatic discontinuation within 24 hours (or 48 hours for cardiac surgery)

  • Empowerment of Pharmacy to determine the dosing schedule post-op

  • Concurrent review for compliance with timing and duration of antibiotic administration

  • Feedback to practitioners on individual performance.

 

SCIP Infection 4: Cardiac Surgery Patients with Controlled 6:00 a.m. Postoperative Serum Glucose (< 200 mg/dL). – (Required to report effective Quarter 1, 2008)

  • Identification of patients with hyperglycemia prior to surgery and appropriate institution of glucose management protocols for monitoring and treating the hyperglycemia at least up to 48 hours post surgery end time
  • Discouraging use of “Sliding scale” insulin alone
  • Developing protocols that clearly establish:
    • Responsibility and accountability
    • Approved hypoglycemia protocols
    • Agreed upon acceptable serum glucose thresholds.

SCIP Infection 6: Surgical Patients With Appropriate Hair Removal – (Required to report effective Quarter 1, 2008)

  • Multiple studies support that preoperative shaving of the surgical site the night before an operation is associated with a significantly higher risk for surgical site infection. The act of shaving causes skin abrasions or microscopic nicks that provide an environment for bacterial colonization. Key changes to provide appropriate hair removal included:

    • Development of a protocol for when and how to remove hair for surgical site preparation
    • Specifying a location on the operative record for documentation of appropriate hair removal
    • Performing hair removal only when necessary using clippers immediately before surgery
    • Removal of all razors from the operating room
    • Education and involvement of patients preoperatively.

SCIP Infection 7: Colorectal Surgical Patients with Immediate Postoperative Normothermia - (Required to report effective Quarter 1, 2008)

IPG hospitals have successfully implemented standardized protocols to identify and prevent causal process-related factors that contribute to hypothermia. Interventions implemented include

  • Standardizing the operative suite ambient temperature

  • Placing warm blankets on the patient upon transfer to the operative bed

  • Limiting heat loss in patients prior to the operative procedure and using warming

    devices to ensure patient temperature >36°C or 96.8°F

  • Using only warmed intravenous fluids, irrigation fluids and inhalation gases

  • Developing protocols for types of thermometers used, frequency of temperature

    readings and interventions for treating below-normal temperatures.

SCIP Cardiology 2: Surgery Patients on Beta Blocker Therapy Prior to Admission Who Received a Beta Blocker During the Perioperative Period – (Required to report as of Quarter 1, 2007)

  • Development of protocols to ensure patients on home beta-blockers take and receive beta-blockers within the perioperative period
  • Ensure that patients who are fasting know to take their beta-blocker within the preoperative period

SCIP-Venous Thromboembolism (VTE)-1: Surgery Patients with Recommended Venous Thromboembolism Prophylaxis Order – (Required to report as of Quarter 1, 2007)and SCIP-VTE-2: Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis Within 24 Hours Prior to Surgery to 24 Hours After Surgery – (Required to report as of Quarter 1, 2007)

 

Key changes included:

  • Development of VTE risk assessment protocol
  • Implementation of VTE prophylaxis based upon risk assessment
  • Development of a mechanism for documentation of VTE prophylaxis
  • Development of standardized protocols for appropriate VTE prophylaxis including timing and interventions.

 

Quality Awards

In March 2007 10 Ohio SCIP6 Hospitals were honored with the SCIP6 Commitment to Quality Award. The award was presented jointly by David Hunt, MD, FACS, Medical Officer, CMS, and Dale Bratzler, DO, MPH, Principal Clinical Coordinator, Oklahoma Foundation for Medical Quality on behalf of the six Quality Improvement Organizations hosting the project (Illinois, Indiana, Kentucky, Michigan, Ohio and Wisconsin). The Ohio award recipients were:

 

Alliance Community Hospital – Alliance, Ohio

Community Health Partners – Lorain, Ohio

Kettering Medical Center – Kettering, Ohio

Licking Memorial Hospital – Newark, Ohio

Mercy Medical Center – Canton, Ohio

Northside Medical Center (Forum Health Western Reserve) – Youngstown, Ohio

Parma Community Hospital – Parma, Ohio

Southwest General Health Center – Middleburg Heights, Ohio

HMHP St. Elizabeth Health Center – Youngstown, Ohio

University Hospitals Case Medical Center – Cleveland, Ohio

 

Excellence is an easy aspiration. A commitment to excellence is a never-ending journey. Congratulations to Ohio’s SCIP6 IPG facilities!

 

 

Three Hospitals' Success in Surgical Care

 

By Barbara G. Stiebeling, RN, MSN, Quality Improvement Project Leader

 

The Surgical Care Improvement Project (SCIP) has enjoyed a high profile from its inception. SCIP’s early beginnings as the Surgical Infection Prevention Project (SIPP) was piloted in the states of Ohio, Kentucky and Oklahoma prior to its expansion into more diverse surgical care beginning in August 2005. This project has modeled inter-agency collaboration at its best and is truly a national program.

 

Twenty-two hospitals in Ohio are participating in the SCIP Identified Participant Group (IPG). Many have made impressive improvements in surgical care. Here are a few of their stories.

 

Kettering Medical Center in Kettering, Ohio in the Dayton area, is a 522- bed not-for-profit acute care community hospital and the largest in the Kettering Health Network. Their interest in SCIP was prompted by the desire to excel. Members of the surgical staff quickly recognized that streamlining their processes would make their operations more efficient and bring more reliable quality services to their patients.

 

According to Beverly Schneider MS, RN, ONC, Manager of Clinical Outcomes for Surgical Service Lines, the biggest change that led to improvement was standardizing surgical order sets. Prior to this initiative, surgeon-specific order sets were used, causing much inefficiency. Upon review, it was noted that practices within specialties were very similar.

 

The cardiovascular surgeons have successfully used standardized order sets for several years. Therefore, it was decided to implement standardized order sets for other surgical types as well. With a few key surgeons leading the way, order sets were re-designed. Initially, visits were made to select institutions to look at their best practices. This was followed with inter-disciplinary work groups that designed order sets specific to surgical procedures, rather than specific to surgeons. As of July 1, 2007, these new and improved order sets have been in use. Embedded in these is the list of appropriate antibiotics for surgical procedures and pharmacy care paths including automatic timing guidelines. This practice is now spreading to the medical arena, where physicians are beginning to look at this model for developing order sets appropriate to medical diagnoses.

 

Mercy Hospital of Tiffin in Tiffin, Ohio is a 108-bed hospital in the northwest region of the state. It is part of the Mercy Health Partners system. One of the major challenges for them, according to Karen Gill, RN, MSN, CNA, BC, Director of Quality Management, was the discontinuation of antibiotics within 24 hours. They took a multi-pronged approach to this challenge, which included discussions at the surgical care review committee, individual discussions with surgeons by surgical managers and most importantly, by assigning responsibility to Post Anesthesia Care Unit (PACU) nurses for identifying and documenting the timeframe for administration of up to three doses of post-operative antibiotics. The first post-operative dose is given 8 hours after the pre-operative dose is given. Up to two additional doses are then given at 8-hour intervals before the drug is discontinued. Their success rate on this measure has progressively improved and is currently 100 percent.

 

 

Southwest General Health Center (SWGHC) in Middleburg Heights, Ohio, in the Cleveland area,

is a 354-bed acute care community hospital and a partner with the University Hospitals Health System. Their interest in improving surgical care prompted them to participate in the SIPP pilot and then to continue on as a SCIP Identified Participant Group (IPG) hospital. With time and experience on their side and a “can do” attitude, they have made significant improvements and continue to maintain them.

 

One of the most difficult tasks was gaining support for discontinuation of antibiotics within 24 hours. The Medical Executive Committee and the Board assisted with this initiative by approving the discontinuation of antibiotics within 24 hours following surgery. This support was essential in gaining compliance yet it did not lead to full goal achievement. A surprise finding according to Colleen Gazzillo, RN, Medical Staff PI Coordinator, was the fact that unanticipated system issues were impacting this measure. How was this uncovered? The staff at SWGHC make excellent use of the data collection tools provided by their vendor. Not only do they review every outlier, but they also follow-up with each staff member, surgeon, etc. Data are posted for all to see and are continually addressed with clinicians.

 

Having an effective physician champion and pharmacist involved has led to great compliance with the administration of antibiotics within one hour of surgery. Education was also a large factor in their success. Their chosen path was to assign the responsibility for these antibiotics to the circulator nurse rather than the anesthesiologist, as is most often recommended. This allowed them the advantage of educating and following up with a smaller group of individuals. Their compliance rate is near 100 percent and has been for some time.

 

Extraordinary surgical care

These three hospitals are providing extraordinary surgical care by following simple, proven rules of quality improvement. They have identified and used effective clinical and administrative leaders, reduced variances in care, used data tools effectively, closely monitored their outcomes and processes, assigned responsibility and accountability for specific tasks and provided feedback to all involved. They set great examples for Ohio hospitals and demonstrate that success is within everyone’s reach. Ohio Medicare beneficiaries are sure to benefit from adoption of these practices.

 

Having an effective physician champion and pharmacist involved has led to great compliance with the administration of antibiotics within one hour of surgery.

 

 

Ohio Receives Mixed Grade on Health Performance Scorecard

 

By Robert A. Feigenbaum, MS, Communications Writer/Editor

 

Ohio achieved an overall ranking of 24 out of 51 (50 states and the District of Columbia) on the Commonwealth Fund’s study, Aiming Higher: Results from a State Scorecard on Health System Performance, which evaluated state healthcare system performance across five dimensions: access, quality, avoidable hospital use and costs, equity, and healthy lives. Anne K. Gauthier, Senior Policy Director, the Commission on a High Performance Health System, The Commonwealth Fund, presented the results of the scorecard at a recent meeting in Columbus of the Health Policy Institute of Ohio.

The scorecard measured health system performance for all 50 states and the District of Columbia using 32 key indicators. The indicators were then organized into the following five broad categories:

  • Access: This includes rates of insurance coverage for adults and children and indicators of access and affordability of care. Ohio ranked 15 out of 51.
  • Quality: This includes indictors that measure three related components—receipt of the “right care,” coordinated care, and patient-centered care. Ohio ranked 23 out of 51.
  • Potentially Avoidable Use of Hospitals and Costs of Care: This includes indicators of hospital care and follow-up, as well as the annual costs of Medicare and private health insurance premiums. Ohio ranked 37 out of 51.
  • Equity: This includes differences in performance associated with patients’ income level, type of insurance, or race and ethnicity. Ohio ranked 14 out of 51.
  • Healthy Lives: This includes indicators that measure the degree to which a state’s residents enjoy long and healthy lives. Ohio ranked 41 out of 51.

Gauthier noted there exists a positive correlation between ranking in quality and ranking in access to healthcare. States that ranked low in access, tended to rank low in quality. In addition, Gauthier emphasized the following projections if Ohio achieved top state performance:

  • More than 400,000 additional adults and children would be insured
  • 400,000 additional adults (age 50+) and 175,000 diabetics would receive recommended care
  • 20,000 additional children would be immunized
  • More than 450,000 adults and 244,000 children would receive primary care
  • There would be almost 10,000 fewer Medicare hospital admissions and readmissions per year at savings of more than $93 million
  • There would be nearly 4,500 fewer premature deaths

 

Universal coverage

The study concludes that universal coverage is a key to improving health care nationally. Specifically, the report stated, “Universal coverage that provides meaningful access to essential care and financial protection is the critical foundation upon which to improve quality and enable more cost-effective care. States that have achieved the highest rates of coverage for adults and children consistently have higher rates of preventive care, care for chronic disease, and continuity of care.”

 

Alvin D. Jackson, MD, Director, Ohio Department of Health, who was on the meeting’s Reactor Panel, amplified the study’s conclusions.

 

“We have a system that is broken and have lots of work to do,” said Dr. Jackson. “Solutions will rest in universal coverage—a mix of public and private ventures.”

 

Dr. Jackson also called for our healthcare system to focus better on where money is spent. He noted that 1 percent of the population consumes 30 percent of healthcare costs and 10 percent of the population consumes 75 percent of the costs. Dr. Jackson believes there needs to be a greater focus on chronic disease, use of technology such as electronic health records (EHRs), and better coordination of care.

 

In commenting on the scorecard, Ronald A. Savrin, MD, MBA, FACS, Medical Director, Ohio KePRO, said, “ We need to establish a system that not only provides all Ohioans with access to the medical care they need, but one that provides high-quality, evidence-based care to all patients .”

 

The Commonwealth Fund is a private foundation whose mission is to promote a high performing healthcare system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults.

 

States that ranked low in access tended to rank low in quality.

 

Hospital Payment Monitoring Program Reduces Error

 

By Jennifer Bitterman, MBA, RHIA, Director, Review Services

 

 

The purpose of Hospital Payment Monitoring Program (HPMP) is to measure, monitor and reduce the incidence of improper fee-for-service inpatient payments including errors in diagnostic related group (DRG) coding, provision of medically necessary services, and appropriateness of setting, billing and prepayment denial. As part of the program, quality improvement organizations (QIOs) such as Ohio KePRO are required to conduct a project focused on reducing the payment error rate (PER).

 

Ohio KePRO performed thorough analyses of all errors found within the National Payment Error (NPE) monitoring samples for fiscal years (FY) 2003 and 2004. These analyses revealed that admission denials account for the majority of payment errors in Ohio. For FY 2004, there were 42 total payment errors for Ohio hospitals. Thirty-two or 76 percent of these errors were admission denials. Fifteen of these 32 admission denials concerned one-day lengths of stay (LOS).

 

In terms of payment, 84 percent of the dollars paid in error for one-day LOS were incurred by six hospitals, which represented 32 percent of the total dollars paid in error for FY 2004. Ohio KePRO developed a project working with these six facilities to reduce the payment errors related to one-day stays. Ohio KePRO believed it could accomplish the following three goals:

  • Project Goal 1: Reduce PER (absolute dollars in error) found in abstraction by 15 percent.
  • Project Goal 2: Reduce total error (cases in error) found in QIO abstraction by 25 percent
  • Project Goal 3: Provider will improve by 50 percent in its critical indicators

QIP process

Ohio KePRO used the quality improvement plan (QIP) methodology to help these six hospitals identify deficiencies in their processes related to admission and documentation of observation services. Ohio KePRO trained the six hospitals to collect and analyze their data to determine the root causes of their errors. The hospitals then developed a focused QIP based on the root causes of their errors, and then monitored the improvements to determine if they were reducing payment errors. The key components of a QIP are the following:

  • Identification of key areas for improvement
  • Identification of plan for accomplishing improvement
  • Setting of goals
  • Identification of who is responsible for carrying out the elements of the QIP
  • Development of a method to measure progress
  • Setting deadlines and monitoring progress over time
  • Following the Plan-Do-Study-Act (PDSA) cycle

 

Hospital QIPs

The following is a brief summary of the actions that the six hospitals included in their QIPs to address problems with one-day stays:

  • Hospital 1. Performed random internal audits regarding medical necessity with its one-day stays. The hospital did not provide methodology/rationale for what they did with the results of this audit. Interestingly, this hospital has shown an increase in their denial rate.
  • Hospital 2. Implemented 100 percent review of Medicare patients to ascertain if they met inpatient criteria. The quality department evaluated any charts not meeting inpatient criteria and education was provided to staff and physicians. This hospital has shown a decrease in their denial rate.
  • Hospital 3. Performed random audits of Medicare charts to determine if they met inpatient criteria. Any charts not meeting inpatient criteria were sent on for physician review (internal) and education provided to those physicians whose charts did not meet criteria. This hospital has shown a decrease in their denial rate and is interested in sharing what they have learned with other providers.
  • Hospital 4. Performed audits of Medicare charts with specific DRGs for which the hospital was an outlier in PEPPER reporting. Case managers in the emergency department (ED) helped facilitate proper placement of patients. Placing their case managers in the ED has not only decreased their Medicare denial rate, but the hospital reports that it has decreased unnecessary admissions from other payers as well as cut down on their seven-day readmit rate. For example, a case manager in the ED will recognize someone who was just released and make a referral to home health or a skilled nursing facility (SNF) rather than the staff placing the patient in observation or even admit him or her.
  • Hospital 5. Reviews all admissions daily for inpatient criteria. The hospital developed a case management program to correct any errors prior to discharge through physician and staff education. The staff working with Ohio KePRO are eager to learn about LEAN methodologies and want to roll out their process improvements to other areas of the hospital that they perceive problems or potential problems.
  • Hospital 6. Performs 100 percent audit of Medicare patients. The hospital uses UR nurses to determine if patients meet inpatient criteria. Any changes occur prior to discharge. The hospital was most reluctant in the beginning, believing Ohio KePRO was wielding a “big stick” and desiring to take away their Medicare funds. After working with Ohio KePRO, they are most receptive and eager to implement their QIP methodologies to other areas of the hospital.

Monitoring the project

In addition to working with the hospitals, Ohio monitored the project. It drew and reviewed baseline, interim, and remeasurement samples. These determined the hospitals’ PER as well as the group’s PER. Ohio KePRO abstracted the data elements necessary to determine each hospital’s PER. These elements mirrored the elements in the review process required by the Centers for Medicare & Medicaid Services (CMS). A nurse using InterQual® criteria did an abstraction. The data were captured in a database enabling Ohio KePRO to report back to the hospitals to determine the effectiveness of the project and the hospital’s interventions.

 

At the interim point in the project, Ohio KePRO found a 14.1 percent statistically significant improvement in the total error rate of the group of hospitals. There was a significant range of improvement from +9.6 percent to –56.6 percent. It found a 12 percent improvement in the PER of the group of hospitals. Of the six facilities that participated, three showed a statistically significant improvement in their errors. These facilities all took actions to implement additional utilization review of cases that previously were not reviewed.

 

Two of the three remaining facilities did not have the improvement they desired due to change in staff/leadership in the case management departments. The last facility is struggling with the definition of observation and believes that it was the reason that they did not make improvement in their error rates.

 

 

Hospitals made great improvements

Although at the interim point of the project Ohio KePRO has not met its goals of 15 percent and 25 percent, respectively (see above), it is still pleased with the results. Since the interim results were determined, Ohio KePRO met with each facility to discuss their current activities and how to make adjustments to the QIP to impact the final remeasurement score. During these meetings Ohio KePRO learned that the facilities were very interested in improving the PER, had made great improvements to their process of monitoring admission necessity, and believed that the project allowed them to improve their compliance with the Medicare program by getting support from senior leadership. Ohio KePRO will publish the final results in upcoming issue of this newsletter.

 

 

The hospitals were very interested in improving the PER, had made great improvements to their process of monitoring admission necessity, and believed that the project allowed them to improve their compliance with the Medicare program by getting support from senior leadership.

 

 

Acute Care Services Team

Ronald A. Savrin, MD, MBA, FACS

Rita Bowling, RN, MSN, MBA, CPHQ

Jennifer Bitterman, RHIA, MBA

Susan Ferrante, ARM

Ann Fitzsimons, RN, MBA

Frances Hober, RHIA, MBA

Dawn Knopp, RN, BSN, CPHQ

Donna Moore, RN, MBA, CPHQ

Patricia Nelson, RN

Karl E. Peters

Liz Simpson

Barbara G. Stiebeling, RN, MSN

Karen S. Terlaak, RN

Mona D. Wendell, RN, BA, MBA

 

Medical Editor: Ronald A. Savrin, MD, MBA, FACS

Editor: Robert A. Feigenbaum, MS

Associate Editor: Barbara G. Stiebeling, RN, MSN

 

 

 



To Contact Us
E-Mail: hospital@ohqio.sdps.org
Provider QIC Line: 1.800.385.5080

 

Rock Run Center, Suite 100 · 5700 Lombardo Center Drive · Seven Hills, OH 44131 · www.ohiokepro.com

 

Ohio KePRO, the Medicare Quality Improvement Organization (QIO) for Ohio, is working with committed hospitals, nursing homes, home health agencies, and physicians throughout the state who are dedicated to the common goal of Continuous Quality Improvement for Medicare beneficiaries.

 

All material presented or referenced herein is intended for general informational purposes and is not intended to provide or replace the independent judgment of a qualified healthcare provider treating a particular patient. Ohio KePRO disclaims any representation or warranty with respect to any treatments or course of treatment based upon information provided.

 

Publication No. 8031-OH-017-10/2007. This material was prepared by Ohio KePRO, the Medicare Quality Improvement Organization for Ohio, 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.