Case Review Connections
Acute Care Edition
Issue 31: September 2022
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Kepro has videos for healthcare providers, to help with their day-to-day work, and for people who have Medicare, to share about our free services.
Watch a video to learn more about Kepro's Case Status tool that you can use to track an appeal that has been filed.
Get information on prevention and how to manage ongoing health conditions focused on physical and mental health. From exercise tips to diet and nutrition, this is your one-stop shop for caring for yourself and loved ones.
Health for older adults:
In the last Medical Director’s column (July), the first four goals of the Centers for Medicare & Medicaid Services (CMS) National Quality Strategy were examined in detail. In this column, the final four goals will be reviewed.
- Strengthen resiliency. With this goal, CMS wants to make sure that the health care system is prepared for and is able to adapt to challenges such as COVID-19. They are developing metrics, quality assurance and improvement programs, conditions of participation, and other actions to evaluate this goal. One of the ways that CMS showed resilience during the pandemic was the use of waivers and other flexibilities.
- Embrace the digital age. With this goal, CMS hopes to ensure timely and secure communication and care coordination between providers, plans, payers, and patients across the care continuum to achieve desired outcomes and provide patients direct access to their information. An example of a current digital innovation is how CMS has been moving forward with telehealth.
- Incentivize innovation and technology adoption to drive care improvements. With this goal, CMS will ensure that scientific data and evidence from all populations served will drive decisions. A recent example of CMS innovation is a new model that CMS is testing to improve cancer care for Medicare patients.
- Increasing alignment. This goal is to align performance metrics, quality improvement efforts, programs, policy, and payment to improve value without being compounded by needless duplication. This includes striving to create a national picture of quality measurement to is understandable to individuals, providers, and payers. CMS has an Office of Burden Reduction and Health Informatics (OBRHI) that focuses on reducing administrative burden and advancing interoperability and national standards.
For more information about the National Quality Strategy, visit the CMS website. The vision for the strategy is that implementing these goals will assure that all persons receive equitable, high quality, and value-based care.
The Case Status tool is available on Kepro’s website to check the status of a hospital discharge or service termination appeal.
When a beneficiary files an appeal, a case number will be assigned. That number can be placed in the tool, and steps 1-8 will appear to explain where the case is during the process.
Kepro has a YouTube video to explain the process in detail.
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 his wife’s prescription medications. When his wife was discharged from the hospital, the medications she had brought from home were missing. The hospital staff called them into the pharmacy, but the representative was told by the pharmacy that they were not there. He was concerned that his wife needed the medications immediately and did not know what to do. He reached out to Kepro for assistance.
The Clinical Care Coordinator (CCC) contacted the hospital and was able to speak with a supervisor. She stated that the prescriptions were originally called in to one pharmacy, but they were closed on the weekend, so they called another pharmacy. The CCC then called the pharmacy where the prescriptions were to make sure they were being filled. The pharmacy staff stated that they were working on filling the 18 prescriptions. The CCC then contacted the representative and told him where he could pick up the prescriptions. The representative stated that he had just got off the phone with the pharmacy, and they are going to work with him so that he can get all of the prescriptions filled soon. The representative then started to cry because he was so overwhelmed and expressed his appreciation for helping him resolve the situation.
There is a new provider type that has been established for rural communities, known as rural emergency hospitals. This new type of rural hospital will become effective January 1, 2023, and will provide needed access to care for rural communities. For more information, view the CMS press release.
On our new Aging Health Matters podcast, we have an episode that explores the challenges of living in a rural community for Medicare beneficiaries and those who care for them. (will link to rural health podcast)
Kepro’s Outreach Specialists are available for joint presentations, quarterly staff trainings, webinars, conference calls, and advisory boards. There is no charge for their services. Visit Kepro’s partner page for details.
For more information about Kepro’s Outreach services, listen to our Outreach podcast.
Publication No. R146810-255-9/2022. 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.