Show #421 Airing 2/17/08
Where can you turn if you believe you've received poor care in a hospital or nursing facility? If you or your family member is on Medicare, help is a phone call away - - you can call Ohio KePRO. Here today to walk us through the case review process is Jennifer Bitterman, Ohio KePRO's review director.
Question: What is Ohio KePRO, and how can it help our viewers with their healthcare concerns?
Answer: Ohio KePRO is a Quality Improvement Organization. Every state has one, and we are the Medicare contractor for Ohio that focuses on ensuring that a Medicare patient gets the right care at the right time, every time.
We work with healthcare providers and beneficiaries to ensure that quality care is available to patients. We look for quality improvements and make sure that best practices are being followed in healthcare settings.
Medicare beneficiaries or their family members can call us, and we perform reviews on behalf of Medicare beneficiaries, concurrently and retrospectively-during treatment and after.
Question: Can you give us a real-life example?
Answer: A daughter called while her mother, a Medicare beneficiary, was admitted to a skilled nursing facility after an operation. Her mom had suffered a skin tear (a deep scratch) while at the facility.
The daughter understood this is a common occurrence, but was concerned at the lack of attention the tear was receiving. It had been 4-5 days and there had been no treatment. When she asked the nursing staff, they told her that her mother's physician had not ordered such treatment.
Ohio KePRO quickly got hold of her mother's medical records and agreed that treatment should have been administered sooner. It turns out that the facility's nursing staff had not notified patient's physician that the tear had occurred. Once notified, the physician promptly ordered treatment.
While Ohio KePRO's phone calls instigated movement and treatment, our role did not end there. We helped the nursing facility review its protocols when it came to notifying physicians-to clarify whose responsibility it was-so that a similar incident would not happen in the future.
Question: What if a Medicare beneficiary is getting discharged, and he/she or the family is concerned that it's too soon?
Answer: We get many phone calls where people feel they, and their loved ones, might need a day or two more in the hospital. In such cases, we get a copy of the patient's medical record and a physician reviewer looks it over to see if the patient is medically stable enough to go home.
In most cases, we find that the patients really are ready. Most expect to feel 100%, and we explain that this is not a realistic expectation. Also, the review process takes 24 hours, people are allowed to stay during the review process, and, in that time, many patients feel much better. However, in any case, it's comforting to know for certain that you can be safely discharged.
And, in some cases, the physician reviewer finds something that the patient's doctor may not have seen yet-like a new lab result-that could necessitate the patient staying a few days longer in the hospital.
Question: And I understand that reviews can even be made retrospectively?
Answer: Yes. We had a gentleman who had a hip fracture and was discharged to a skilled nursing facility. He feared that he was having a problem with his incision site. It was uncomfortable and sore, but also itchy and red, and there was also some discharge. He had asked staff about it and felt that they had not listened to his concerns.
Ohio KePRO pulled his charts and saw that orders for treatment of this infection had been placed and followed through.but no one had told the patient. He had been receiving antibiotics and had more frequent dressing changes, but did not realize it.
We worked with the facility so they could develop a best practice of communication.
Question: How can our viewers get more information?
Answer: A. They can call Ohio KePRO to learn more. We are also giving away a free Know Your Rights Kit. It explains the rights of Medicare beneficiaries as well as explains Ohio KePRO's role in case reviews.
If you're concerned about the healthcare you or a loved one is receiving, call Ohio KePRO. Their mission is to help you, and they can take steps to make sure others won't experience the same problems. The Ohio KePRO is also happy to send you a Know Your Rights Kit, free. Call the number that's next. My thanks to Jennifer Bitterman.
