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Case Review Connections 

Acute Care Edition

Issue 32:  November 2022

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If you want to communicate BFCC-QIO information, please contact Kepro at QIOCommunications@kepro.com and request a newsletter insert or fact sheet for your organization. Please do not copy and paste information from Case Review Connections.


YouTubeKepro has videos on YouTube for healthcare providers, to help with their day-to-day work, and for people who have Medicare, to share about our free services.

join us for a webinar

Join our Outreach staff for an informative webinar about Kepro on Wednesday, November 30, 2022. The webinar will provide basic information about the services that Kepro offers for Medicare beneficiaries:

  • Quality of care complaints,
  • Appeals, and
  • Immediate Advocacy services.

Register for the Webinar

If you have difficulty registering, send an email to QIOCommunications@kepro.com.

november is family caregivers month

Family Caregiver Month

Get information and resources you can share with your patients and community:

in this issue:

medical director's corner - jessica whitley, md, mba

The Institute of Healthcare Advancement sponsored Health Literacy Month in October to integrate and expand the mission of health literacy. Health literacy is a central focus of Healthy People 2030. One of the initiative’s overarching goals demonstrates this focus: “Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all.” Six Healthy People objectives are related to health literacy:

  • Increase the proportion of adults whose health care provider checked their understanding
  • Decrease the proportion of adults who report poor communication with their health care provider
  • Increase the proportion of adults whose health care providers involved them in decisions as much as they wanted
  • Increase the proportion of people who say their online medical record is easy to understand
  • Increase the proportion of adults with limited English proficiency who say their providers explain things clearly
  • Increase the health literacy of the population

Per this National Institutes of Health (NIH) article, "improving health outcomes relies on patients’ full engagement in prevention, decision-making, and self-management activities. Health literacy, or people’s ability to obtain, process, communicate, and understand basic health information and services, is essential to those actions. Few Americans are proficient in understanding and acting on available health information.

The Department of Health and Human Services has proposed a Health Literate Care Model to improve patient engagement in health care. The model calls for approaching all patients with the assumption that they are at risk of not understanding their health conditions or how to deal with them and then subsequently confirming and ensuring patients’ understanding. Health literacy experts have begun to advocate health literacy universal precautions. Initially, the concept of universal precautions applied to across-the-board preparations instituted by health care organizations to prevent the transmission of blood-borne diseases among patients. Adopting health literacy universal precautions acknowledges that the complexity of the health care system challenges virtually everyone.

Although some providers may initially object that becoming a health-literate organization would be too time-consuming, implementing a Health Literate Care Model could ultimately serve to reduce duplication and inefficiency while improving patients’ understanding of and engagement in health care.” According to the NIH, “health literacy is not just the right thing to do for the patient. It is also the right thing to do to make sure we control costs and improve quality.” Here is their business case for health literacy:

Health literacy may help cut health care costs through:

  • Fewer emergency department visits
  • Fewer hospital readmissions
  • More screenings to prevent illness and increase medicine adherence
  • Fewer dosing errors

Helpful website and more information:

appeals: teaching videos on youtube

Kepro gets requests from providers asking about teaching their staff about various notices, especially those that are not issued frequently like the HINN 1. Our YouTube channel has a whole library of videos that provide instruction on each of the various notices that Kepro reviews. Check it out and hit subscribe if you find the videos useful.

Examples of Kepro videos:

alerthhs announces listening session on protecting the safety of patients and healthcare workers

Join the U.S. Department of Health and Human Services (HHS), including leaders from the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid Services (CMS), and the Food and Drug Administration, on Monday, November 14 as they recommit to the advancement of patient and healthcare worker safety.

HHS Secretary Xavier Becerra will convene the chief executive officers of the country's largest healthcare systems, board members, and organizational patient safety leaders in a livestreamed listening session. They will be joined at the podium and around the table by patient and family advocates.

Get the details about the listening session: www.ahrq.gov

immediate advocacy success story

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 the beneficiary’s wound care at the hospital. The representative had filed an appeal, and she was concerned that the hospital staff had stopped wound care for the beneficiary. The beneficiary had been on antibiotics, but the white blood cells had continued to rise. There had been a large increase overnight, and the representative was concerned, so she requested an intervention by Kepro.

The Kepro Clinical Care Coordinator (CCC) was able to speak with the Director of Case Management. She stated that the white blood cells were actually down. She stated that wound care had not been stopped, but the wound care nurse did not see patients daily. The staff will perform a thorough assessment of the wound and make recommendations for the nursing staff to continue with the dressing changes. The CCC then contacted the representative to explain what was occurring, and the representative thanked the CCC for the information and for making the call on her behalf.

health equity: mapping medicare disparities

The CMS Office of Minority Health developed a tool called the Mapping Medicare Disparities (MMD) Tool.  This is an interactive mapping tool that allows users to identify areas of disparities between Medicare sub-groups (e.g., by race and ethnicity, age, sex, and dual eligibility status) in health outcomes, utilization, and spending.

Watch a video to learn how the tool works: Mapping Medicare Disparities MMD Tool 

outreach services

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 website for details.

Below is a testimonial from an Oklahoma LTC Ombudsman, a Kepro stakeholder, sharing how Kepro has assisted them.

“Kepro has been invaluable in helping Medicare recipients during the discharge process, whether that is from the hospital setting or the skilled nursing setting. If a recipient or their representative feels they are being discharged prematurely or without the necessary resources, we have referred them to Kepro’s helpline. Kepro can evaluate that discharge and take the necessary steps to ensure the recipient's rights are being respected, and their needs are being appropriately met.”

Publication No. R146810-262-11/2022. 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. 

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