MoPRO Annual Report - Primaris

2002
ANNUAL
REPORT

contents
Section I. . . . . . . . . Pages 5-12
Health Care Quality Improvement
Section II . . . . . . . Pages 13-16
Payment Error Prevention
Section III. . . . . . . Pages 15-16
Consumer Protection
Section IV . . . . . . . . . . Page 17
Health Care Consulting
Section V . . . . . . . . . . Page 18
Board of Directors

(L-R): James T. Rogers, MD, FACP (Springfield), Chairman of the Board,
Richard A. Royer (Columbia), Chief Executive Officer
open letter
In 2000 the Centers for Medicare & Medicaid
Services (CMS) set an ambitious strategic goal
for MissouriPRO: statewide improvement in 23
indicators of care across seven clinical topics
by 2003.
Needless to say, the task was daunting.
Success would require working with all 101
acute care hospitals and a significant portion
of the 20,000 physicians that serve almost
900,000 Missourians enrolled in Medicare.
In spite of the challenges and very short
timeframe, Missouri’s health care community
heard our "call to action" and achieved
improvement. By 2002, Missouri jumped from
33rd to 26th in the nation in quality care
provided to Medicare beneficiaries.
beneficiaries and reduce hospital adverse
events associated with surgical/invasive
procedures. All these accomplishments help
ensure quality and safe health care for
Missouri’s residents.
Overall, 2002 has been a tremendous year for
MissouriPRO. As this report clearly
demonstrates, collaboration marks the heart
of our success. We thank all of our esteemed
partners, Missouri Hospital Association, Missouri
Association of Osteopathic Physicians and
Surgeons, Missouri State Medical Society,
CMS, and each and every health care
provider who made a conscious choice to
collaborate with us to create positive change
in the quality and safety of health care in
Missouri. Our accomplishments are also the
result of the strong commitment and
dedication of our Board of Directors and staff.
We look forward to the new challenges CMS
presents in 2003 and beyond.
Our accomplishments this year go beyond
achieving our quality improvement goals.
Through the efforts of our Payment Error
Prevention Program, Missouri’s inpatient
payment error rate was reduced by 11%. Our
internal case review process was awarded
Health Utilization Management Accreditation
by URAC. Moreover, we were awarded
several grants; a few of which are to increase
mammograms among St. Louis African
American women, monitor Medigap
guaranteed issue rights for Medicare
Sincerely,
James T. Rogers, MD, FACP
Chairman
Richard A. Royer
Chief Executive Officer
2

our
Committed to positive change in
health care quality
Mission
3

Achievements
2000-2002
• Missouri jumped from 35rd to 28th
in the nation in overall quality of
care provided to Medicare
beneficiaries.
• For the first time, 113 out of 114
hospitals worked on improving
quality of care in at least one
national clinical topic.
• Missouri was one of the first 10
states to begin rapid cycle
collaboratives among hospitals
and physician offices designed
to improve patient care quickly
and efficiently.
• Diabetes care was significantly
enhanced for almost 9,000
beneficiaries who received
lipid profile, A1C, and retinal
eye exams.
• Over half (54%) of Medicare
patients admitted to the hospital
for a heart attack and who smoke
were counseled to quit, a 16%
increase from 1998 estimates,
placing Missouri third in the US on
this indicator of care.
• Three-out-of-four Medicare
beneficiaries were immunized
against influenza in 2001; a nearly
10% increase over two years
earlier and 5% higher than the
national average of 72%.
• Over 68,000 Medicare women
received their annual mammogram;
2,588 more than in previous years.
• Missouri’s inpatient Medicare
payment error rate dropped 11%,
an estimated savings of $4.3 million
to the Medicare Trust Fund.
• 40,000 seniors were reminded to
get their flu and pneumonia shots
through a partnership with the
Show-Me State Adult Immunization
Coalition.
• Over $3.5 million in out-of-pocket
expenses were saved for more
than 15,000 Medicare consumers
through counseling provided by
our CLAIM Program volunteers.
• Maintained 99% timeliness on all
mandatory case reviews,
exceeding the national
requirement of 80%.
• Awarded 6 additional contracts for
external review of Medicaid
managed care, quality
improvement in critical access
hospitals, Medigap, patient safety,
breast cancer public education
and smoking cessation.
• Received three public
relations/marketing awards.
4

Quality Improvement
Hospitals
MissouriPRO encourages hospitals to
measure performance in order to
understand and improve their systems of
care. Evidence suggests that welldesigned
system changes significantly
reduce readmissions, improve quality of life,
and reduce health care costs while
improving patient self-management and
satisfaction.
We provide hospitals with reports on their
performance in clinical topics chosen by
CMS along with national, statewide, and
benchmark rates. These reports help
hospitals strategically evaluate their care.
5
When an opportunity for improvement in
care is identified, MissouriPRO assists
hospitals in examining their processes,
pinpointing system breakdowns, and
choosing appropriate solutions. Hospitals
can make changes quickly with access to
our comprehensive, evidence-based
quality improvement resources, including
pocket cards for physicians, tip sheets, and
chart stickers. This year, over 75,000 tools
were ordered by Missouri hospitals.
We also offer opportunities for hospitals to
interact in structured Collaboratives.
Participants are exposed to interactive
learning sessions where teams study
methods of change, and action periods
where teams test and implement changes

in their facilities. In 2002, 11 critical
access hospitals participated in a
Collaborative sponsored jointly by
MissouriPRO and Missouri
Department of Health & Senior
Services (DHSS), Office of Rural
Health. The project was designed
to prevent system failures and
medication errors. MissouriPRO
also joined a team from Heartland
Regional Medical Center in the first
nationwide Surgical Site Infection
Prevention Collaborative hosted by
CMS.
Further enhancing our work with
hospitals is our participation in a
Patient Safety Demonstration
Project. MissouriPRO, in partnership
with DHSS, HealthInsight (the Utah
QIO), and the Utah Department of
Health, is working with hospitals to
identify critical processes and
causes related to adverse surgical
events, barriers to change, and
Stroke/Atrial
Fibrilation
Quality Indicator
Avoidance of sublingual nifedipine
Antithrombotic at discharge
address lessons learned.
MissouriPRO has designed and
conducted a chart review process
to identify adverse surgical events
and evaluate the use of ICD-9
codes for predicting adverse
events. Conferences and regional
meetings have also been held to
promote patient safety best
practices in participating hospitals.
Through this approach, Missouri
hospitals have achieved impressive
results. Within three years hospitals
improved in 14 of 17 indicators of
care (see graph). Increases
measuring 10% or more were
recorded in smoking cessation
counseling and time to angioplasty
for patients admitted with an AMI,
as well as in screening and/or
administration of pneumonia and
influenza immunizations for patients
with pneumonia. Missouri was
among the top 10 states in the
amount of improvement for aspirin
at discharge, smoking cessation
counseling, and time to
angioplasty.
The next three years of work on
CMS’ national clinical topics will be
demanding. Surgical site infections
will be added. We will be
expected to assist hospitals in
continued improvement as we
simultaneously double our work
with expansion into home health
and nursing homes. We plan to
move from individual consultations
to group work in the form of
Collaboratives and regional
education meetings. We will
continue to make our system
change tools available to every
hospital and place our
educational materials on our
website.
Baseline (%) / Remeasurement (%) Rate
5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100
84 83
92 99
Quality Improvement
Discharge on warfarin
52 59
Heart Failure
Pneumonia
Appropriate use/non-use of ACEI at discharge
Appropriate initial empiric antibiotic
Antibiotic within 8 hrs of admission
79 84
81 85
84 84
Blood culture prior to antibiotic
Influenza vaccine (or screening)
Pneumococcal vaccine (or screening)
16 28
15 25
77 79
Acute
Myocardial
Infarction
ACEI at discharge for low LVEF
Early administration of beta blocker
Beta blocker at discharge
59
74 74
67
72 78
Smoking cessation counseling
38 54
Early administration of aspirin
76 81
Aspirin at discharge
78 88
Combined minutes to angioplasty/thrombolysis
37 56
Adult
Immunizations
Influenza vaccinations
Pneumonia vaccinations
53 64
68 77
Diabetes
Annual HbA1c
72 78
Biennial lipid profile
57 71
Biennial retinal exam
67 68
Breast Cancer
Biennial mammogram
54 59
6

Physician Offices
Improving the quality of care in the outpatient setting
can be taxing given the sheer numbers of physicians
and clinics serving Missouri seniors. To do so, we
sought to communicate continually with physicians
about our free assistance and systems change tools.
We employed targeted mailings and faxes,
educational ads and articles in physician journals and
magazines, and face-to-face contacts at physician
offices, conferences, and presentations. Partnership
helped us further spread this information into the
physician community. In the coming three years, we
will expand our work with physician offices through
Collaboratives and individual consultation where
possible.
7
Atchison
Holt
Nodaway
Worth
Gentry
Andrew
DeKalb
Buchanan
Platte
Clinton
Clay
Jackson
Cass
Bates
Vernon
Barton
Jasper
Newton
McDonald
Mercer
Harrison
Daviess
Johnson
Dade
Barry
Grundy
Caldwell Livingston
Ray
Lafayette
Henry
St. Clair
Cedar
Lawrence
Carroll
Hickory
Polk
Greene
Stone
Putnam
Sullivan
Linn
Saline
Pettis
Benton
Chariton
Christian
Webster
Taney
Morgan
Dallas
Schuyler
Scotland
Adair
Macon
Camden
Randolph
Howard
Cooper
Moniteau
Boone
Wright
Cole
Miller
Laclede
Douglas
Ozark
Knox
Shelby
Pulaski
Monroe
Audrain
Osage
Texas
equal to or greater
than state average
state average = 72.7%
(average of statewide
rates for A1C, lipid
profiles and retinal
eye exams)
Clark
Lewis
Callaway
Maries
Marion
Phelps
Howell
Ralls
Gasconade
Dent
Diabetes Monitoring Rates
Pike
Oregon
Franklin
Crawford
Shannon
less than state average
Washington
Iron
Reynolds
Carter
Ripley
Jefferson
St. Francois
Madison
Wayne
Butler
Diabetes
Many older adults die each year
from diabetes or suffer from
related complications including
blindness, kidney failure, nerve
damage, and cardiovascular
disease. Complications can
St. Louis
St. Louis City be prevented or delayed
through regular clinical
monitoring and selfmanagement.
Ste.
Genevieve
Lincoln
Montgomery
Warren St. Charles
Cape
Girardeau In 2002, eight physician
offices participated in
Scott
MissouriPRO’s first
Stoddard Mississippi
Diabetes
New
Madrid Collaborative. Using a
model that specifies the
Dunklin
essential elements of
excellent diabetes care,
these clinics have achieved
impressive results. Patients
meeting the national goal of two
A1C tests per year increased 397%
after the Collaborative, and by
September, 520 patients were
enrolled in active care registries.
These clinics are now expanding
their improvements to other
chronic diseases and additional
sites.
Bollinger
Perry
Pemiscot
Clinical partnerships also play a
key role in diabetes improvement.
This past spring, the Kansas City
Quality Improvement Consortium
produced and distributed
evidence-based medical
guidelines for the treatment of
diabetes and heart failure to over
1,400 physicians. Rather than
referring to multiple sources, these
guidelines provide one reference
point for practicing physicians.
Representatives of local
physicians, medical associations,
insurers and medical schools
comprise the group, along with
MissouriPRO.
Missouri is improving in diabetes
care. Compared to two years
earlier, 12,612 more Medicare
diabetes patients obtained a
biennial lipid profile, 9,474 more
received an annual A1C, and
6,423 more had a biennial eye
exam. Still, most counties in
Missouri need additional
improvement.

Immunizations
Thousands of people are hospitalized and die each year from flu and pneumonia—two vaccinepreventable
diseases. Most are over age 65. Although effective vaccines exist for these diseases,
Missouri’s immunization rates are substantially lower than the Healthy People 2010 goal of 90%.
The Show-Me State Adult Immunization Coalition is a strategic partnership of private corporations,
community organizations, and government agencies. The Coalition partnered with 27 local health
departments on a statewide flu shot campaign for the 2002-2003 flu season. Flu brochures with local
flu clinic locations and dates were mailed to over 40,000 Medicare beneficiaries in 27 counties with the
lowest immunization rates. MissouriPRO also targeted physicians practicing in counties with the lowest
immunization rates, in an effort to alert them of the poor rates within their county and offer free tools to
increase immunization rates.
Quality Improvement
Through these efforts, we are making steady progress toward our 90% immunization goal. Three-out-offour
Medicare beneficiaries were immunized against influenza in 2001, a nearly 10% increase over two
years earlier. The percentage of Medicare beneficiaries who have been immunized against
pneumonia since 1991 also increased to 64—11% higher than two years earlier.
Atchison
Holt
Nodaway
Worth
Gentry
Andrew
DeKalb
Buchanan
Platte
Mammography Rates
Clinton
Clay
Jackson
Cass
Bates
Vernon
Barton
Jasper
Newton
McDonald
less than national
average
equal to or greater
than national average
national average = 60.2%
(Medicare women age 50-69
who received a mammogram)
Mercer
Harrison
Daviess
Johnson
Dade
Barry
Grundy
Caldwell Livingston
Ray
Lafayette
Henry
St. Clair
Cedar
Lawrence
Carroll
Hickory
Polk
Greene
Stone
Putnam
Sullivan
Linn
Saline
Pettis
Benton
Chariton
Dallas
Christian
Webster
Taney
Morgan
Schuyler
Scotland
Adair
Macon
Camden
Randolph
Howard
Cooper
Moniteau
Boone
Wright
Cole
Miller
Laclede
Douglas
Ozark
Knox
Shelby
Pulaski
Monroe
Osage
Texas
Clark
Lewis
Callaway
Maries
Marion
Ralls
Audrain
Phelps
Howell
Gasconade
Dent
Pike
Crawford
Shannon
Oregon
Washington
Iron
Reynolds
Carter
Ripley
Breast Cancer
According to the American Cancer Society, next year 4,000 women in
Missouri could be diagnosed with breast cancer and nearly 800 could
die from the disease. While mammography is effective at detecting
breast cancer in its earliest, most treatable stages, this service is underutilized
among older women. Only 59% of Medicare women age 50 to
69 had a mammogram between 10/1999 and 10/2001—7% below
Missouri’s achievable benchmark of 67%.
Jefferson
Patient reminder systems have proven to be very effective in ensuring
women receive a mammogram. Over 195 clinics and physician offices
use the mammography recall system provided by MissouriPRO.
Lincoln
Montgomery
Warren St. Charles
St. Louis
Franklin
Community partnerships and strategies support the clinical changes.
MissouriPRO, the American Cancer Society, and the Breast and
Cervical Cancer Control Project, developed a 2002 Mother’s Day
Campaign to raise awareness about the value of mammography
screenings. Sixty-four mammography centers implemented the
St. Louis
City
campaign in their communities. In fall 2002, we promoted use of
Barnes-Jewish Hospital’s Mammography Van in St. Louis. Reminders
Ste. were mailed to 4,000 Medicare women who did not get a
Genevieve
Perry mammogram in the last two years. The reminders, mailed
Madison Cape twice for reinforcement, included information about the
Girardeau
value of mammography, Medicare coverage, and the van
Scott
schedule at local Schnucks markets. A grant from the
Stoddard Mississippi
Butler
St. Louis Affiliate of the Susan G. Komen Breast Cancer
New
Madrid Foundation will allow us to expand this partnership activity
in 2003 to African American women in St. Louis.
St. Francois
Wayne
Bollinger
Dunklin
Pemiscot
8

Nursing Homes
Improvements in medical care and technology
result in people living longer. With a longer life
span and shorter acute care stays, the burden of
care is falling to nursing homes and home health
agencies. Providing quality improvement
resources in these settings will become an
important focus of our work in the coming years
while maintaining improvement in the acute
care and outpatient settings.
9

Fall Prevention
To prepare for this work, MissouriPRO
initiated the Fall Prevention Project for
Skilled Nursing Facilities. Preventing falls
and maintaining mobility is a vital quality
of life issue for nursing home residents but
can be difficult to achieve due to age,
frailty, and physical dependence.
The 12 nursing homes chosen for participation
were receptive to improvement and
eager to learn methods to enhance the
quality of life for their residents. They
received hands-on individual consultation
and education along with a toolkit
containing guidelines and techniques to
assist them in their quality improvement
work. The toolkit included samples of
materials that the homes could modify for
their use, such as policies and procedures,
forms for risk and neurological assessments
and fall investigation, and resident care
plans.
Facilities were encouraged to adopt a
care model with the essential elements of
a sustainable fall prevention program—risk
assessment, care planning, and exercise.
MissouriPRO assisted facilities in developing
and implementing a risk assessment for
every resident, with particular emphasis on
new residents shortly after admission.
Included in this assessment was identification
of medications that could cause falls.
Several facilities rewrote their policies and
procedures related to falls to establish an
ongoing process that would not vary with
staffing changes. Risk assessments were
completed on each facility’s setting to
identify and eliminate environmental
hazards that could contribute to falls.
Using this information, a falls team could
develop individual care plans and revise
them regularly.
Several facilities were especially successful
with the "Falling Leaf Program," a special
observation program that included all
facility staff. The program identifies a small
number of residents at high risk for falls and
provides specialized observations and
interventions to determine resident’s
needs.
This project is also a success for
MissouriPRO. It allowed us to test
interventions and strategies to improve
care and outcomes in a setting other than
acute care. It has also established a
relationship with nursing homes and
helped define future activities for the next
three years where we will be expected to
achieve statewide improvement in three
clinical indicators.
Over the year of the project,
beginning July 2000, facilities
reduced their repeat falls by 30%.
Most of the improvement was due
to the use of a resident
observation program, low beds
and system reviews. Not only did
facilities develop successful fall
prevention programs; they
learned the essentials of the
quality improvement process.
They embraced the team
approach to assessment, care
planning, interventions, and
mobility activities for residents.
10
Quality Improvement

Managed Care
Approximately 140,000 older adults in
Missouri are covered by a Medicare
managed care plan. The Quality
Improvement Systems for Managed
Care (QISMC) Program helps protect
their right to quality health care.
MissouriPRO assists plans to implement
QISMC by providing them with
technical assistance on project
development and evaluation, as well
as access to our quality improvement
resources.
In 2002, we also supported collaborative
efforts directly impacting care in
Medicare managed care plans. The
Kansas City Quality Improvement
Consortium, which included
commercial and publicly funded
MCOs, disseminated uniform treatment
guidelines for diabetes, heart failure,
depression, and asthma to over 1,400
physicians in Kansas City. We were
instrumental in developing and
distributing these guidelines which
included CMS’ national indicators for
heart failure and diabetes. In the
St. Louis region, MissouriPRO is a
member of the St. Louis Diabetes
Coalition, also comprised of both public
and commercial health plans.
11

Quality Improvement
Underserved Populations
In St. Louis a 70-year-old African American
gentleman has never had the flu shot and,
in his judgement, never will. "I’ve never had
the flu, so why start now?" He is set in his
ways, he admits. He’s not alone.
In the metropolitan St. Louis area, a mere
37% of African Americans age 65 and older
were immunized against the flu, according
to 1997 Behavioral Risk Factor Surveillance
System data. This compares to 80% for non-
African Americans.
Since identifying this gap, MissouriPRO is
working to increase influenza immunization
rates among African Americans living in
St. Louis. A central feature of the project is
an intensive discovery phase to gain a
culturally competent understanding of the
community and to identify barriers to
change.
that included local flu clinic information
mailed to Medicare consumers.
A comprehensive and culturally-directed
mass media campaign drove home the
message of the importance and safety of
flu shots.
Our results so far have shown strong
evidence for providing accessible clinics
supported by effective social marketing
methods and culturally competent
interventions to increase flu
immunizations among older
African Americans. We are
committed to continuing
this project for an additional
three years. Our goal is to
build on successes to establish
a sustainable communitybased
framework.
Working closely with the St. Louis
Influenza Immunization Advisory
Committee, the number of local
flu clinics were increased or
relocated and promoted to
increase access. To promote the
clinics, we developed a variety of
social marketing strategies to
reach older African Americans
during the 2001-2002 and 2002-
2003 flu seasons. Our most
successful strategy was a postcard
12

Payment Error Prevention
This year Missouri’s inpatient Medicare
payment error rate declined to 2.01%, from
2.25% two years earlier. This 11% reduction
followed nearly three years of quality
improvement interventions facilitated by
MissouriPRO as part of our Payment Error
Prevention Program (PEPP) activities.
The PEPP, initiated by CMS in 2000, was
designed to reduce the national payment
error rate and to reduce the percentage of
Medicare dollars improperly paid for
inpatient services. It was a response to an
Office of the Inspector General audit.
13

Project Results
The statewide payment error rate declined following
implementation of several projects facilitated by MissouriPRO.
Declines in error rates were achieved in all projects associated
with unnecessary admissions. The error rate related to
inappropriate same day readmissions dropped to 27%, a
decline of 14% from two years earlier. Hospitals that had the
highest number of same day readmissions (Level III) at the
beginning of the project showed a more dramatic decline in
errors, dropping to 5% from 59% (see graph #1). The number
of claims for DRG 462 dropped from a statewide high of 82 to
14 at last measurement (see graph #2). Errors associated with
short stay admissions increased from 8% to 30%, even though
hospitals targeted for more intense intervention because of
their high rate of short stay admissions had an error rate
decline of 11% at last measurement.
Our project designed to decrease DRG coding errors
associated with several pulmonary conditions showed a
relative improvement of 14% - 20% at remeasurement for
DRGs 99/100. However, these were the only two DRG
conditions among the 8 reviewed, with improvement. A
recent measurement found a statewide error rate of 12%; 2%
higher from two years earlier. Statistically significant increases
in error rates were observed in DRGs 79/80 and DRG 475.
Error Rate
100%
80%
60%
40%
#1 Same Day Readmission Errors
PEPP
Interventions
Reduction in payment errors followed nearly three years of
collaborative quality improvement activities with Missouri’s
acute care hospitals. Our focus promoted accurate coding,
appropriate utilization, and complete medical record
documentation to reduce errors associated with unnecessary
admissions and miscoded DRG assignments.
To evaluate areas of potential payment error in Missouri we
used pattern analysis, medical record abstraction, and
analysis of claims data. Once areas of concern were
identified, hospitals were encouraged to examine their
coding and utilization policies, procedures, and processes.
We provided technical assistance to hospitals on selfmonitoring
and auditing techniques.
To help hospitals address sources of errors, several resources
were developed including documentation and coding tools.
This year we produced and distributed quality improvement
resources designed to help hospitals reduce errors related to
short stay admissions. Supporting our individual consultation,
we used a variety of statewide educational efforts, ranging
from our quarterly Prevention Pays newsletter, radio public
service announcements, and local informational meetings
throughout the state.
MissouriPRO will continue to monitor payment error rates in
Missouri by analyzing data from several sources including CMS
and our review data. Interventions and projects will be
developed and implemented on the results of our analysis.
20%
Remeasurement
Baseline
0%
14
Level I Level II Level III Statewide
Baseline Remeasurement
#2 Rehabilitation DRG (462)
billed Medicare inpatient
82
0 20 40 60 80 100
14

Consumer Protection
Ensuring that the nearly 900,000
Missouri Medicare consumers are
aware of their rights and benefits is
important to our mission. To
accomplish this, we combine the
strengths of our helplines, case review
process, traditional education and
outreach activities, and the advice
and support of our Beneficiary
Services/CLAIM Advisory Committee.
To further supplement our beneficiary
program we offer the services of
CLAIM.
15

Helplines
For Medicare consumers help is just
a phone call away. From February
1, 2002, to October 31, 2002, our
Medicare Helpline (1-800-347-1016)
and CLAIM Program Helpline (1-800-
390-3330) received over 7,000 calls.
When consumers call our Medicare
Helpline, staff is ready to respond to
concerns regarding patient rights
and quality of care.
Case Review
Brochures and booklets about
patient rights and preventive
services are mailed upon request.
Assistance is offered for immediate
appeals of hospital or managed
care discharge letters. Also, callers
concerned about the quality of care
they received can file quality of care
complaints. Our URAC-accredited
review process ensures all concerns
are addressed professionally and
timely. We also review cases
referred to us by fiscal intermediaries
and carriers, EMTALA (anti-dumping)
cases, and hospital requests for
reassignment of a claim to a higherweighted
DRG. Calls about issues
other than these are handled by
CLAIM or appropriately referred to
other organizations that can provide
assistance.
CLAIM
When consumers have specific
questions about Medicare
coverage, CLAIM can help. By
calling CLAIM, consumers are
Case Review Summary 2/1/2002-10/31/2002
Number
Type of Review
Reviewed Findings
Higher weighted DRGs 878 32 requests denied
PEPP reviews 605 25 admission denials
10 DRG changes
5 quality concerns confirmed
HINNs/NODMARs 27 5 notices reversed
Referrals from other agencies 36 0 DRG changes
0 quality concerns confirmed
0 admission denials
EMTALA 59 33 five-day reviews
26 sixty-day reviews
Beneficiary complaints 63 20 quality concerns confirmed
connected with one of over 250
CLAIM volunteer counselors across
the state who can answer questions
about Medigap policy comparisons,
Medicare benefits, Medicare Cost
Savings Programs, Medicare+Choice
options, long-term care insurance,
appeals of denied claims, and
assistance with prescription drug
coverage. Thanks to our CLAIM
counselors, Medicare consumers
saved over $1,250,000 in out-ofpocket
expenses last year and are
more knowledgeable health care
consumers.
Outreach
Phone calls alone are not relied
upon to reach the Medicare
consumer—we actively reach out to
them before they need us. We offer
a variety of traditional education
and outreach efforts, ranging from
our consumer newsletter, to
calendars and radio PSAs, to local
informational meetings throughout
the state. This year we produced
two consumer newsletters, presented
at 98 health fairs, mailed 7,500
calendars, and sponsored five radio
PSAs.
As Missouri’s older adult population
grows and diversifies, MissouriPRO
continues to turn to our Beneficiary
Services/CLAIM Advisory Committee
for guidance. Comprised of
Medicare consumers, senior
advocates, and representatives of
various organizations, this committee
contributes perspective on and
assistance with reaching older
adults. Over the next three years we
will be expanding the membership
of our consumer advisory committee
as well as its responsibilities.
Consumer Protection
16

Health Care Consulting
The MissouriPRO continues its dedication to
assisting health care professionals deliver
quality, cost-effective care through our
health care consulting services. In
addition to our work with health care
providers under our Medicare contract,
the MissouriPRO offers consulting and
grants administration services to state and
federal governments, non-profit and forprofit
organizations.
These services include expertise in program
design and evaluation, data collection
and analysis, quality improvement systems,
medical record review and abstraction,
compliance, and external reviews. The
MissouriPRO was recently certified in
Utilization Review Accreditation and
Certification (URAC) for utilization
management review.
activities of our Medicare contract and of
the organization as a whole. Our
constituent and business development
team works to develop new business
opportunities and services to the health
care community and to identify emerging
business opportunities and trends. This
includes proactively developing new
business opportunities, responding to grant
and contract proposals, and developing
projects to be funded by private
foundations.
Through this work, the MissouriPRO
continues to advance health care
practices and policies forward by
providing strategic interventions, data
analysis, contract management and
consultation to our partners in the health
care community.
Our efforts include informing our state and
national elected officials and state
agencies on the quality improvement
17
Credits
Editors: Deborah Finley & Melody Kroll
Design & Layout: Firehouse Design
Printing: Brown Printing

MissouriPRO Board
Standing (L-R):
Kenneth E. Ross, DO (House Springs)
Marc Smith, PhD (Jefferson City)
David A. Hardy, MD, FACS (Richmond Heights)
H. Jerry Murrell, MD (Columbia)
Robert E. King, DO (Springfield)
Carl G. Bynum, DO, MPH (Jefferson City)
James T. Rogers, MD, FACP (Springfield)
Jeffrey G. Copeland, MD, FACS (St. Charles)
Turner L. Minnigerode, MD (Kansas City)
Jerry D. Kennett, MD (Columbia)
Gregg R. Laiben, MD (Kansas City)
Richard A. Royer (Columbia)
S. Gordon Jones, Jr., MD (Sikeston)
G. Richard Hastings II (Lee’s Summit)
Walter F. Davisson, MD (Chesterfield)
Joseph M. Yasso, Jr., DO (Independence)
Mark Aeder, MD, FACS (Kansas City)
Seated (L-R):
Pat Mills, MBA, CPA (Jefferson City)
James D. Smith, DO (Kirksville)
Janis VanMeter (Lewistown)
Hazel Borders (Kansas City)
Bonnie Bowles (Jefferson City)
Donald J. Babb (Bolivar)
MO-02-31-GEN This material was prepared by MissouriPRO under contract with the
Centers for Medicare & Medicaid Services (CMS). The contents presented do not necessarily reflect CMS policy.
18

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Jefferson City, MO 65109
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