The Carolinas Center for Medical Excellence (CCME), under contract by the Centers for Medicare & Medicaid Services (CMS), serves as the Quality Improvement Organization (QIO) for North and South Carolina. These contracts are performance-based and focus on improving quality of care services for the nearly 2 million people with Medicare living in the Carolinas. We work with care providers from hospitals, nursing homes, and physician offices to implement evidence-based practices. This translates into better care for the patient and also valuable cost savings for the provider.

One of our goals as the QIO is to work with health care providers to improve areas of patient safety and disease prevention, as well as provide case review services to ensure people with Medicare receive the best possible care.

Patient Safety
For several years, we have been working extensively with hospitals in North and South Carolina to improve health care processes and systems to reduce medical errors. Current Medicare-sponsored quality improvement initiatives on surgical safety and heart failure treatment in hospitals build on the work that we began many years ago. In the ninth contract cycle with CMS, we are promoting new initiatives, such as the reduction of the incidence of health care-associated Methicillin-resistant Staphlylococcus aureus (MRSA) infections and the prevention and healing of pressure ulcers in hospital patients.

We have also been working closely with Carolina nursing homes for many years on patient safety. In addition to reducing the incidence of pressure ulcers within nursing homes, we are continuing our work on lowering the usage of physical restraints in these facilities.

CCME has created a one-of-a-kind, online resource to promote a Medicare initiative for drug safety education and awareness.The website, Drug Safety in the Carolinas Medicare Population, allows users to query and generate detailed information on drug safety measures. Pharmacists, health care practitioners, researchers, educators, managed care organizations, and others who are interested in studying drug safety may obtain comprehensive reports of drug-on-drug interactions (DDI) and potentially inappropriate medications (PIM) within demographic groups for Medicare Part D enrollees at the county, regional, and state levels in North and South Carolina.

Disease Prevention
Building on our previous work in disease prevention activities, we are working with a select group of physician practices in the Carolinas that has already implemented an electronic health record (EHR) system certified by the Certification Commission for Healthcare Information Technology (CCHIT). Collaborating practices will work with us to implement care management processes, using their certified EHRs, to improve their rates of breast cancer and CRC screening and influenza and pneumococcal vaccination and report their data to CMS.

Case Review Services
Mandatory case review contributes to improved quality of care for people with Medicare in North and South Carolina. Whenever specific requests or referrals are made, our review team of health care professionals conducts quality, utilization, and coding determinations on individual cases. Such review allows us to provide oversight on medical necessity, appropriateness and quality of care delivered to Medicare patients.

For more information, please visit: www.ccmemedicare.org.