Case Review Connections
Post-acute Care Edition
Issue 29: May 2022
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The Centers for Medicare & Medicaid Services (CMS) held their annual quality conference, New Hope, New Health: Charting a Path Forward, on April 12-13, 2022. CMS estimated that 5,000 participants would attend this year.
The purpose of the conference was to “convene leaders across the healthcare spectrum, to explore how patients, advocates, providers, researchers, and champions in healthcare quality improvement can develop and spread solutions to address America’s most pervasive health system challenges.”
Some of the featured topics during the Grand Plenary included the Keynote Address: Building Equity on a Foundation of Quality as well as a roundtable discussion about the CMS National Healthcare Quality Strategy goals, which include:
- Embedding quality across the care journey
- Advancing health equity
- Fostering engagement with stakeholders with focus on person and family-centered care
- Promoting safety to achieve zero preventable harm
- Strengthening resilience in the healthcare system
- Embracing the digital age
- Incentivizing scientific innovation and technology
- Increasing alignment to promote seamless and coordinated health care
At the end of the Plenary, there was a presentation with direct feedback from patients on how to chart the path forward.
Kepro presented at one of the sessions titled Using Plain and Empathetic Language to Communicate with Medicare Beneficiaries. Kepro noted continued improvements in terms of empathy and grade level with their letters sent to beneficiaries at the end of a quality of care review. There was another Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) breakout session on the second day of the conference titled Health Equity: Lessons from the Field. This session focused on how BFCC-QIOs are working to break down barriers to eliminate disparities.
For more information about the conference, please visit www.cmsqcvirtual.com/agenda.
Recently a provider called Kepro with questions about issuing an appeal notice when Medicare is the secondary payer. Kepro confirmed with CMS that providers have always been required to deliver the appeal notice to Medicare beneficiaries in a Medicare-covered stay, whether Medicare is primary or secondary. However, if Medicare is the secondary payer, such as in a motor vehicle accident or with an incarcerated patient, and is not covering any of the stay, then the beneficiary would not have any appeal rights.
Immediate Advocacy is an informal process in which the BFCC-QIO acts as a liaison for people with Medicare to quickly resolve an oral complaint. Kepro would like to share success stories with providers to show how Immediate Advocacy can benefit providers by resolving problems quickly, which leads to improved patient relations.
A beneficiary’s representative contacted Kepro with concerns about her mother’s hospice services being reduced. The hospice was decreasing her days with an aide from five to three. The representative just wanted more information about the decision and requested help from Kepro.
The Clinical Care Coordinator (CCC) called the hospice and explained the situation. The hospice nurse stated that the beneficiary was not showing decline and had been on services for two years. The CCC stated that the representative had been noticing weight loss, and the beneficiary was no longer walking. The CCC then called the hospice administrator for more information. The hospice administrator noted that the beneficiary can walk. She stated that the hospice physician would be going out to visit the beneficiary the following week to evaluate for continued hospice services. The CCC thanked her and requested that they notify the representative when the hospice physician would be there, so that she could be there to ask questions. The CCC then called the representative to let her know that the hospice physician would be out for an evaluation. The representative expressed her appreciation and said she looked forward to the visit by the hospice physician.
During the CMS Quality Conference in April 2022, there was a session on Updating the CMS Rural Health Strategy. In the past, there have been five objectives:
- Apply a rural lens to CMS programs and policies
- Improve access to care through provider engagement and support
- Advance telehealth and telemedicine
- Empower patients in rural communities to make decisions about their healthcare
- Leverage partnerships to achieve the goals of the CMS Rural Health Strategy
During the conference, CMS invited interested individuals to provide feedback related to the following:
- What can CMS do to advance health equity in rural and frontier communities, Tribal Nations, including U.S. territories?
- Which of the CMS Rural Health Strategy objectives should CMS continue to prioritize?
- What is missing from the current CMS Rural Health Strategy objectives?
Kepro was invited to present at the CMS, Indian Health Service (IHS), Tribal Health Programs, and Urban Indian Programs (ITU) annual virtual training in CMS Regions 1,4,6,8 and 10. Kepro was pleased to have the ability to reach an important demographic and inform them of our services of requesting a discharge appeal, receiving help with Immediate Advocacy, and how to file a quality of care complaint. While tribal elders may have access to Indian Health Services and tribal medical centers, many are still covered by Medicare and do not live in a tribal community. It is important for them to be aware of the benefits of Medicare coverage. We are excited to expand our relationship with IHS and tribal communities.
Publication No. R146810-244-5/2022. This material was prepared by Kepro, a Medicare Quality Improvement Organization 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.