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e-Reports, March 21, 2011
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If you care for Medicare patients, you should know Indiana’s Medicare Quality Improvement Organization, Health Care Excel, also has a mission to serve those patients Untitled document

Recent threatened cuts to Medicare reimbursement brought physicians a great deal of anxiety and concern. But have you ever considered what would happen to your patients, your practice, your livelihood if the Medicare Trust Fund went totally broke?

Earn extra income as HCE case reviewer
You can step up to serve as a Health Care Excel (HCE) case reviewer and earn extra dollars in these financially challenging times. Reviewers get paid for each case they review.

However, reviewers must be practicing physicians, working a minimum of 20 hours a week and seeing Medicare beneficiaries. Reviewers must also have hospital privileges.

“Become part of the process of improving quality care,” said Roland Grieb, M.D., M.H.S.A., HCE medical director. “The work is true peer review and important to the Medicare program and the people who count on it.”

Dr. Grieb, the only full-time employed physician at HCE, explained that HCE does not have a host of physician administrators but relies solely on practicing physicians to conduct case reviews.

Medicare quality improvement organizations or QIOs, like Health Care Excel (HCE) in Indiana, work to keep that from happening. The job of the national network of 53 QIOs – in states, U.S. territories and the District of Columbia – is to make sure we are all good stewards of Medicare’s resources.

“We must be more aware of the care we provide,” said HCE Medical Director and ISMA member Roland Grieb, M.D., M.H.S.A. “We all recognize there will be many issues to deal with if the Medicare Trust Fund runs out.”

Does that mean HCE’s sole purpose is to cut costs, save money for the federal plan? “Saving money is not a bad thing,” said Dr. Grieb, “as long as it’s not at the expense of quality care.” And that’s where the QIOs find their mission, which is to improve the effectiveness, efficiency, economy and quality of services delivered to Medicare beneficiaries.

“So many of us in our office – and likely in yours – are dealing with elderly parents. That makes us passionate about what we do for Medicare beneficiaries,” Dr. Grieb explained.

The role of a QIO
The Centers for Medicare & Medicaid Services (CMS) issues three-year contracts to each QIO and tasks them to:

  • Ensure Medicare pays only for services and goods that are reasonable, necessary and delivered in the most appropriate setting
  • Address beneficiary complaints, provider-based notice appeals, violations of the Emergency Medical Treatment and Labor Act (EMTALA) and other responsibilities detailed in QIO-related law

“Whether you deliver care in a hospital or elsewhere, you are directly or indirectly impacted by HCE, so it’s important you know who we are,” said Dr. Grieb. The QIO organization receives calls and inquiries from hospitals, pharmacists, nursing homes and others. “Not all of our work impacts physicians, but it does impact the care their Medicare patients are receiving.”

Dr. Grieb
Roland Grieb, M.D., M.H.S.A.

When patients are unhappy about their care or they want an appeals process because care is terminated or denied, HCE assists them. In hospitals, HCE deals with core measures, as reported on Hospital Compare, that directly affect physicians.

In medical practices, HCE encourages doctors to get an electronic health record (EHR) system. “We also work with those who already have an EHR to help them better utilize their systems to achieve meaningful use,” explained Dr. Grieb.

In addition, HCE collaborates with the Indiana State Department of Health, nursing homes and others on initiatives to decrease pressure ulcers and health care acquired infections like MRSA – because their focus is always on patient safety.

The focus has changed
If you’ve been around Indiana health care for a while, you may recall when QIOs were referred to as “the PRO,” or Peer Review Organization. Dr. Grieb explained that today’s organization differs in many ways.

“The focus has changed. Medicare QIOs are now less punitive than in the past and more focused on ensuring quality and patient safety,” he noted. “We encourage doctors to participate in improvement efforts, crossing all settings of care to improve processes and bridge the gaps. In doing so, we impact physicians in a variety of ways.”

Watch upcoming issues of ISMA Reports for more on HCE’s Care Transitions Project that seeks to eliminate potentially preventable hospital readmissions.

If you have questions about HCE, contact Dr. Grieb at (812) 234-1499, ext. 221.

Current goals and priorities
Health Care Excel has focused on the following priorities in its current three-year program with the Centers for Medicare & Medicaid Services:
  • Beneficiary Protection - Protecting the rights of Medicare beneficiaries concerned about the quality of their health care
  • Patient Safety - Improving the safety of care in nursing homes and hospitals by decreasing rates of pressure ulcers, use of physical restraints and incidences of MRSA infection – and by improving inpatient surgical safety and care of heart failure patients
  • Prevention - Increasing rates of screening mammography, colorectal screening, and flu and pneumonia vaccination by helping primary care physicians make effective use of electronic health records
  • Care Transitions - Improving patient transitions from the hospital to home, skilled nursing or home health care with the goal of reducing unnecessary hospital readmissions
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