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 QIP. 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 QIP 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 QIP. After successful
completion of the QIP, Ohio KePRO sends a letter to the provider indicating the
case has been closed. A typical QIP 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.