We work with Ohio healthcare providers to improve quality of care delivered to Medicare beneficiaries and reduce payment, coding, and utilization error rates.
Quality improvement plans
(QIPs) are valuable tools to help correct issues of concern related to quality, utilization, and coding. Ohio KePRO reviews individual cases or trends in review outcomes prior to asking a provider to complete a Quality Improvement Plan. If necessary, Ohio KePRO helps the provider develop the plan. Ohio KePRO is required to notify the Centers for Medicare & Medicaid Services (CMS) if a provider refuses to participate in the development of a quality improvement plan.
A Quality Improvement Plan should contain the following elements:
At predetermined intervals, Ohio KePRO monitors the progress of the Quality Improvement Plan. After successful completion of the Quality Improvement Plan, Ohio KePRO sends a letter to the provider indicating the case has been closed. A typical Quality Improvement Plan allows enough time to analyze the data, determine if there is a problem, determine the root cause of the problem, and develop a plan of action to resolve the problem. Implementation of the plan should take only a few days -- ideally the solution to the problem should be as simple as possible. Measurement should occur at intervals based on the implementation plan -- typically we would expect initial measurement to occur soon after implementation, then one month, three months, and six months later. At each measurement phase the provider should evaluate if the steps taken have improved the measurements. If not, then the provider should go back to step one and restart the process.
(QIPs) are valuable tools to help correct issues of concern related to quality, utilization, and coding. Ohio KePRO reviews individual cases or trends in review outcomes prior to asking a provider to complete a Quality Improvement Plan. If necessary, Ohio KePRO helps the provider develop the plan. Ohio KePRO is required to notify the Centers for Medicare & Medicaid Services (CMS) if a provider refuses to participate in the development of a quality improvement plan. A Quality Improvement Plan should contain the following elements:
- Description of the root-cause analysis performed
- Description of measurable expected outcomes and goals
- Description of actions to be taken to correct the quality concern
- Assignment of responsibility – who will do each step
- Time frame for initiating and completing the plan
- Description of the process for ensuring the actions, resolve the pattern of concern
- Method to monitor and measure progress
At predetermined intervals, Ohio KePRO monitors the progress of the Quality Improvement Plan. After successful completion of the Quality Improvement Plan, Ohio KePRO sends a letter to the provider indicating the case has been closed. A typical Quality Improvement Plan allows enough time to analyze the data, determine if there is a problem, determine the root cause of the problem, and develop a plan of action to resolve the problem. Implementation of the plan should take only a few days -- ideally the solution to the problem should be as simple as possible. Measurement should occur at intervals based on the implementation plan -- typically we would expect initial measurement to occur soon after implementation, then one month, three months, and six months later. At each measurement phase the provider should evaluate if the steps taken have improved the measurements. If not, then the provider should go back to step one and restart the process.
