Ohio KēPRO :: Glossary

Ohio KēPRO - Your Medicare Quality Improvment Organization

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AAFP	American Academy of Family Physicians.
ACC	Assistant Clinical Coordinator. A physician or other health professional who consults with Ohio KePRO on cooperative projects.
AFIB	Atrial Fibrillation. An irregular beating of the heart that increases the risk of stroke.
AHCA	The Agency for Health Care Administration. This agency develops and carries out policies related to the Medicaid program in Florida.
AHQA	The American Health Quality Association. This is the national trade organization for quality improvement organizations.
AHRQ	The Agency for Healthcare Research and Quality. This agency supports research designed to improve the outcomes and quality of health care, reduce its costs, address patient safety and medical errors, and broaden access to effective services.
AMI	Acute Myocardial Infarction. The medical term for heart attack.
AOPHA	The Association of Ohio Philanthropic Homes, Housing and Services for the Aging. This organization represents more than 330 health care retirement housing and community service providers, located in more than 150 cities and towns in Ohio.
ASC	Ambulatory Surgery Center. A freestanding facility or unit that operates exclusively for the purpose of providing surgical services to patients not requiring inpatient hospitalization, i.e., the patient comes to the facility, has the surgery, and goes home on the same day.

CAC	Consumer Advisory Council. A committee consisting of 12 to 15 members from counties throughout Ohio. The CAC meets four times per year. It advises Ohio KePRO on health and Medicare issues of importance to beneficiaries. Committee members also keep Medicare beneficiaries informed of Ohio KePRO’s activities and services. CAC members represent Ohio KePRO at health fairs and other events.
CAH	Critical Access Hospital. Facilities that offer emergency and short-term inpatient care.
CASPRO	Clinical Area Support Quality Improvement Organization. A QIO selected by CMS to coordinate national projects (and local projects when appropriate) by providing other QIOs with bibliographies, news items, technical guidance, and tested interventions.
CAT	Clinical Area Team. A panel of CMS staff with medical or technical expertise that provides guidance on a particular national health care quality improvement project.
CDAC	Clinical Data Abstraction Center. One of two data collection facilities based in York, Pennsylvania, and Rockville, Maryland, used by CMS to gather national data for quality improvement and payment error prevention projects and programs.
CMHC	Community Mental Health Center. A facility that delivers partial hospitalization services (specialized outpatient mental health services) to Medicare beneficiaries.
CMS	The Centers for Medicare & Medicaid Services. The federal agency that oversees the Medicare and Medicaid programs. Ohio KePRO is under contract with CMS.
CORF	Comprehensive Outpatient Rehabilitation Facility. A facility that provides diagnostic, therapeutic, and restorative services to outpatients for the rehabilitation of injured, disabled, or sick persons.
CQI	Continuous Quality Improvement. According to the Joint Commission on the Accreditation of Health Care Organizations, this is an approach that builds upon traditional quality assurance methods by emphasizing the organization and systems, (rather than individuals), the need for objective data with which to analyze and improve processes, and the idea that systems and performance can always improve even when high standards appear to be met.

DASTRO	Disadvantaged Populations Area Support QIO. A designated QIO to support DPAT (please see below) as well as coordinate activities and information for the entire QIO community regarding disadvantaged populations health care improvement projects.
DHHS	Department of Health and Human Services. A cabinet level department of the federal government.
DME	Durable Medical Equipment. Items covered under the Medicare program prescribed by a physician for a patient’s home use, e.g., oxygen equipment, wheel chairs, and so on.
DO	Doctor of Osteopathy.
DPAT	A panel of CMS staff with medical and technical expertise that manages/directs health care quality improvement efforts involving a given disadvantaged/vulnerable population, e.g., African American, Hispanic, and so on.
DRG	Diagnosis Related Group. A classification of hospital admissions based on the reason for admission, any co-morbidities or complications that existed during the hospitalization, and any surgery performed. DRGs are part of the Prospective Payment System (PPS) that involves reimbursement to hospitals for the care they provide to Medicare patients.

EOPO	Eastern Ohio Physicians Organization. Bargaining organization for physicians in the Youngstown, Ohio area.
ESRD	End Stage Renal Disease. The point of renal (kidney) disease when dialysis is required to maintain life. Care at this point of the illness is covered by a Medicare benefit most of the time. The patient may or may not be a candidate for renal transplant. One of Ohio KePRO’s alternate setting projects involves improving cardiovascular care and health in ESRD patients.
ESRD Network	The ESRD Network is a not for profit organization that monitors quality of dialysis care in Ohio, Kentucky, Indiana, and Illinois. The ESRD Network is a contractor with CMS.

FFS	Fee for service. Traditional Medicare payment method.

HCQIP	The Health Care Quality Improvement Program or Health Care Quality Improvement Projects. This is a national program to improve health care quality through cooperative projects conducted by QIOs with providers.
Health Seniors 2001	A collaborative effort of multiple private and government agencies that collaborates to improve the health of seniors.
HF	Heart Failure. An inadequacy of the heart so that it fails as a pump to maintain the circulation of the blood. Congestive heart failure (CHF) is frequently used as a synonym for heart failure.
HHA	Home Health Agency. Public or private agencies that specialize in giving skilled nursing services and other therapeutic services, such as physical therapy in the home.
HINN	Hospital Issued Notice of Noncoverage. A letter issued by a hospital to a Medicare beneficiary (or his/her representative) to communicate that services are not covered and the patient, rather than Medicare, must pay for such services.
HIPAA	Health Insurance Portability and Accountability Act of 1996. A complex statute that addresses a number of diverse issues within the health care and health insurance fields, including portability of health coverage, Medical Savings Accounts, electronic data sets for use in health care transactions, health care crimes, long-term contracts, and COBRA. New HIPAA regulations became effective in May 2003.
HPMP	Hospital Payment Monitoring Program. It is from the HPMP CDAC cases that CMS develops the payment error rate for Ohio. The CDAC screening cases are a random selection of 67 cases for all of the Ohio prospective payment system (PPS) hospitals. When analysis of the CDAC review indicates that there is a pattern of errors in a particular area of coding or inappropriate admissions, Ohio KePRO will develop an intervention to address the problem area.

Local Project	A health care project developed within a QIO’s own state or specific area or population of the state.
LPN	Licensed Practical Nurse.
LTC	Long term care.

MA Plans	Medicare Advantage Plans. The new name for Medicare managed care plans contracting with the federal government that are reimbursed for services provided to Medicare patients or "enrollees" through Medi-care dollars. QIOs are required to provide assistance to MA Plans as they conduct their own quality improvement projects (which the plans are required to perform as a condition of their contract as MA Plans).
MAQPRO	Medicare Advantage Quality Peer Review Organization. A QIO selected by CMS to coordinate survey activity of the MA Plans by region. The MCQPRO for Ohio is the Colorado PRO.
MD	Doctor of Medicine.

National Project	A health care quality improvement project involving a CMS-selected disease topic, condition, or treatment. The same project is carried out nationally for all QIOs, using essentially the same tools and methods. For the 6th SoW, the following are Ohio KePRO’s National Projects: Acute Myocardial Infarction (AMI), Flu and Pneumonia, Diabetes, Atrial Fibrillation and Stroke, Heart Failure (HF), and Breast Cancer (Mammography).

OAHP	Ohio Association of Health Plans. Trade Association for managed care plans.
OBN	Ohio Board of Nursing.
OCA	Other Contract Activities. Those parts of the QIO’s contract that involve individual case review, investigation of complaints, and beneficiary review.
ODA	Ohio Department of Aging.
ODH	Ohio Department of Health.
ODJFS	Ohio Department of Job and Family Services. Formerly, Ohio Department of Human Services (ODHS).
OHA	Ohio Hospital Association.
OHCA	Ohio Health Care Association. An organization of for-profit nursing homes assisted living and skilled facilities.
OHIMA	Ohio Health Information Management Association. This organization, which consists of health information management professionals, provides support to Ohio KePRO through educational programs on coding, medical records, and health information.
OMB	Ohio Medical Board.
OMP	Ohio Medicare Partners. This is a group of several agencies that work together on behalf of Medicare beneficiaries. The agencies of OMP are Adminastar Federal (Medicare Part A), Nationwide (Medicare Part B), Adminastar Federal (DMERC--Durable Medical Equipment Carriers), Ohio Deparment of Health, Ohio KePRO, Ohio Department of Aging, Ohio Senior Health Insurance Information Program, Ohio Department of Human Services, and the Social Security Administration.
OOA	Ohio Osteopathic Association.
OSHIP	Ohio Senior Health Insurance Information Program. Provides information on Medicare supplemental insurance, Medicare HMOs, long-term insurance, and Medicaid.
OSMA	Ohio State Medical Association.

PA	Physician Advisor. A term used by Ohio KePRO’s Review Program to describe a physician reviewer. A PA is involved with the review of medical records to determine appropriateness, utilization, and quality of care issues involving Medicare beneficiaries. A PA must be a licensed doctor of medicine, osteopathy, dentistry, optometry, or podiatry. A PA also refers to a Physician’s Assistant. A Physician’s Assistant is a trained allied health professional who supports the delivery of health care in hospitals and physicians’ offices.
PDC	Project Data Collection. The objective collection of specified information from a sample of medical records for HCQIP and PEPP.
PEPP	Payment Error Prevention Program. A program during the 6th SoW that identified and reduced payment errors at prospective payment system (PPS) hospitals. Payment errors included underpayments and overpayments. Participation in PEPP was mandatory for PPS hospitals.
PEPSPRO	Payment Error Prevention Program Support QIO. A designated QIO that supported the PEPAT and all QIOs throughout the nation with coordination of information related to payment error identification, interventions, and projects.
PPS	Prospective Payment System. A predetermined set of formulas for making flat-rate Medicare payments to acute care hospitals and skilled nursing homes.
PRO	Peer Review Organization, now Quality Improvement Organization.
PRONET	Peer Review Organization Network. A training, research, and support network for public members of health care regulatory and governing boards.

QIO	Quality Improvement Organization.
QISMC	Quality Improvement System for Managed Care. CMS’s requirements for MA Plans to perform and report operational and healthcare quality improvement efforts.

RC	Review Coordinator. A term used by Ohio KePRO for non-physician reviewers whose principal responsibilities include medical record review (case review) and medical record abstraction for HCQIP and PEPP projects. RCs must be licensed practical or registered nurses or Registered Health Information Administrators (RHIAs) or Registered Health Information Technicians (RHITs).
RFP	Request for Proposal. An invitation by an entity such as CMS that invites QIOs or other potential contractors to submit technical proposals and bids for contracts.
RN	Registered Nurse.
RO	Regional Office. A regional branch of CMS. There are 10 regional offices in the U.S., 4 of which are responsible for the QIO program.

SC	Steering Committee. A group of provider, physician, and beneficiary representatives that meet four times per year to discuss new quality improvement projects, follow the progress of on-going projects, and to provide advice and input to the HCQIP and PEPP Teams.
SDPS	Standard Data Processing System. SDPS was created in 1995 was created in 1995 to replace the various existing QIO systems and to reduce cost in support of the CMS mission to improve the quality of care for Medicare beneficiaries and assist the Office of Clinical Standards and Quality (OCSQ). The SDPS is a very large system with its own Intranet and WAN capabilities to transmit and receive date, e-mail, and reports for national, regional, and local projects as required by the 6th SoW.
SI/IS	Severity of Illness and Intensity of Service. These are criteria, developed by InterQual, which are used to assess the care given to Medicare beneficiaries.
SNF	Skilled Nursing Facility. Specially qualified facilities that have the staff and equipment to provide nursing care or rehabilitation services and other health-related services.
SoW	Scope of Work. All of the work a QIO is required to complete according to the terms of its contract with CMS. QIOs follow the same SoW regardless of their contract start dates. Ohio KePRO currently operates under the 6th Scope of Work.
SSA	Social Security Administration.

TPEPP	The PEPP version of TQIP (please see below). A computer program that documents PEPP’s project plans, activities, and events.
TQIP	Tracking for Quality Improvement Projects. A computer program tool for QIOs to use for reporting progress, barriers, lessons learned, measurements, and successes to CMS staff. It is used by the project officer and CMS to evaluate the effectiveness of the QIO. It also provides information that permits QIO to QIO comparisons.

VHA	Volunteer Hospitals Association. An organization of affiliated hospitals throughout the United States. Approximately 40 hospitals in Ohio belong to the VHA.

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