Ensuring Medicare beneficiaries receive appropriate, necessary health care that meets professionally recognized standards has long been a goal of the Quality Improvement Organization (QIO) program. Additionally, the Centers for Medicare & Medicaid Services (CMS) is increasing its emphasis on transparency – making quality and price information available to the public – so that patients and families can make more informed decisions when choosing healthcare providers.
Oklahoma Foundation for Medical Quality will continue to support CMS in these endeavors in the next phase of the QIO program (August 2008 - July 2011). In the Beneficiary Protection Theme, we conduct statutorily-mandated review activities, including patient complaints and appeals. We also provide much needed technical support to Oklahoma hospitals in collecting and reporting data that is used to measure quality.
Opportunity for Quality Improvement
Individual patient complaints and provider medical record reviews are important starting points for analysis of quality improvement opportunities. In our 35 years performing case review, quality improvement and reporting assistance for Oklahoma healthcare providers, OFMQ understands the link between case review and quality improvement, and we work collaboratively with providers to improve the healthcare system. We use data related to case review activities as well as widely accepted quality performance measures to help providers identify opportunities for improvement. Our quality improvement activities focus on system-level change and our goal is to improve overall healthcare quality.
Beneficiary Protection Activities
Complaints and Appeals - We review all patient complaints and appeals cases with timeliness and accuracy, and we are empathetic to all parties’ needs. Our staff of medical records analysts, nurses and clinical quality improvement specialists work together to create an open, trusting environment for the provider and the patient. We have a network of more than 300 physician reviewers representing 40 specialties to help ensure expert review. Read more about complaints and appeals here.
Qualitiy Data Reporting - OFMQ supports all Oklahoma hospitals in submission of quality data for reporting and Annual Payment Update (APU) purposes. We provide education and technical assistance on the use of CMS reporting systems such as the Clinical Abstraction and Reporting Tool (CART), QualityNet, and the QIO Clinical Warehouse.
Beneficiary Helpline - Additionally, we provide a beneficiary hotline to provide callers with information concerning Medicare beneficiary rights and responsibilities, and we provide an annual report on our case reviews.
Resources
Medicare QIO Program: www.cms.hhs.gov/QualityImprovementOrgs/
CMS: www.cms.hhs.gov/BeneComplaintRespProg/
MedQIC: www.QualityNet.org/medqic (click on “Beneficiary Protection”)