Institution-specific data on hospital-acquired conditions (HACs) are now available on the federal Hospital Compare website. The information includes hospital-specific and national rates for eight conditions. These are: foreign object retained after surgery, air embolism, blood incompatability, Stage 3 and 4 pressure ulcers, falls and trauma, vascular catheter-associated infection, catheter-associated urinary tract infection and manifestations of… Continue Reading
Attorney Examines External Appeals Landscape
If self-insured health plans across New York decided to offer the external appeals procedures already available to enrollees in traditional plans, the result would be at least a 40% jump in the number of consumers eligible to use the state’s system. That’s according to a white paper just published by an expert attorney with New… Continue Reading
Authors Analyze Quality Improvement in US
More groups than ever before are engaged in concerted efforts to improve healthcare quality in the U.S., according to experts at the Chicago-based Joint Commission. Writing in the April 2011 edition of Health Affairs, authors Mark R. Chassin, MD, MPP, MPH and Jerod M. Loeb, PhD credit ongoing efforts by Medicare-funded Quality Improvement Organizations, New… Continue Reading
IPRO Supports Medicaid Fraud Recoveries
IPRO’s identification of wasteful and fraudulent services billed to Medicaid in New York is resulting in substantial recoveries, under an innovative State and County-based demonstration program. Under the twelve-county pilot that began in 2006, local governments share in net savings resulting from audits and investigations undertaken in collaboration with New York State. In Westchester County,… Continue Reading
IPRO to Headline Reform Seminar
The expanding role of independent review organizations (IROs) in handling consumer-originated external appeals of health plan coverage decisions under health reform is the subject of a morning seminar slated for later this winter in Manhattan. Sponsored by the Northeast Business Group on Health (NEBGH) and moderated by IPRO, the session will examine the intricacies of… Continue Reading
Technology Can Help in Reducing Medication Errors
In its landmark 1999 report, To Err is Human, the Institute of Medicine (IOM) found that medication errors contribute to 7,000 deaths a year. In Preventing Medication Errors (2006), the IOM estimated more than 1.5 million preventable adverse drug events in the nation each year. Medication errors are far too common in all settings of… Continue Reading
QIO-Led Initiative Seeks to Reduce MRSA Risk for Medicare Beneficiaries
The Centers for Medicare & Medicaid Services (CMS) established the National Patient Safety Initiative (NPSI) under its 9th Statement of Work (SOW) for quality improvement organizations (QIOs), which began August 2008. As part of this initiative, all 53 QIOs are working with hospitals across the nation to reduce rates of methicillin-resistant Staphylococcus aureus (MRSA) infection… Continue Reading
Feds Outline Medicaid Audit Roles
States have until December 31 to indicate whether they plan to contract with one or more Medicaid “Recovery Audit Contractors” (RACs), according to an October 1 directive to State Medicaid Directors from the Centers for Medicare & Medicaid Services (CMS). The federal health reform law designates Medicaid RACs as contingency-fee based contractors, similar to the… Continue Reading
Regulators Analyze Quality Expenses
The medical loss ratio recommendations recently sent to HHS by the National Association of Insurance Commissioners (NAIC) spell out the quality improvement expenses regulators believe ought to be recognized as direct care rather than administrative expenses to health plans. Under health reform, the Secretary of HHS is tasked with promulgating uniform cost definitions for health… Continue Reading
IPRO Sponsors Diabetes “Graduation”
IPRO and Univision radio have scheduled a “Diabetes Wellness Workshops Graduation” event to be held November 10 at the Betances Community Center in the Bronx. More than 200 Hispanic and African American seniors are scheduled to take part in the recognition program, which will include a self-care teach-in, musical entertainment and a dance class. The… Continue Reading