Medicare firm opens new office

Friday, August 27, 2004 | 12:00 a.m. CDT; updated 6:57 p.m. CDT, Wednesday, July 2, 2008

There’s a new federally designated Medicare quality improvement organization in town.

After 20 years in Jefferson City, the Missouri Patient Care Review Foundation, also known as MissouriPRO, opened a new office on 200 N. Keene St. in mid-July.

MissouriPRO received $6 million from taxpayers through performance-based contracts handed out by the Centers for Medicare & Medicaid Services and about $1.5 million from other non-Medicare contractors.

MissouriPRO CEO Richard Royer said his organization will bring new federal revenue into Columbia every year and attract people from all over the state for conferences.

“It’s a lot easier to get people in and out of town here in a day’s time than it is in Jefferson City,” Royer said. “Secondarily, Jefferson City is very focused on state government, and that’s not what our business is largely about.”

Royer added that several of MissouriPRO’s 70 employees have already relocated to Columbia.

“We’re a good economic impact on the area,” Royer said.

MissouriPRO is a nonprofit consulting firm contracted by the federal and state government to improve the quality of care in health-related institutions such as hospitals, physicians’ offices and nursing homes.

The Department of Health and Human Services formed peer review organizations 20 years ago as a method of investigating complaints by Medicare beneficiaries. Eight years later, the program was changed to have peer reviews implement improvements to health-care organizations.

It is required by Medicare law that each state be represented by a quality-improvement organization. Thirty-eight of these organizations cover 50 states and three territories. Royer said having the quality improvement organizations in place is crucial for assessing the quality of health for the amount of money Medicare is paying.

He added that in the past three years, Missouri moved up in the rankings of Medicare quality from 35th to 28th. Royer said he would like to see the state rank in the top five.

Medical institutions must provide performance data to the federal government, and MissouriPRO is responsible for helping them improve scores that measure medical quality. If state health care institutions don’t meet their goals by a statistically significant number, the federal government would likely put MissouriPRO’s contract up for bid.

“There are about eight different competitors that I’m sure would love to have an opportunity to grow and be a bigger organization,” MissouriPRO spokesman Andrew Shea said. “Fortunately, we’ve never had to ever defend our contract, and part of that reason is we’re pretty successful at what we do.”

MissouriPRO has been working on a number of projects with institutions around the state. Mary Schantz, executive director of the Missouri Alliance for Home Care, said MissouriPRO monitors and runs Home Care Compare, a program that helps consumers find information about home health agencies.

“The whole goal is for agencies to improve their outcomes,” Schantz said. “I find them to be a very good organization to work with.”

Chief Development Officer Ilalyn Irwin said MissouriPRO is finishing up a project with the Department of Health and Senior Services that looks at thousands of medical-record reviews by nurses to see whether certain codes could be flags for medical error.

“It’s real exciting to be on that edge of patient safety and technology,” Irwin said.

MissouriPRO plans to expand into different fields. Royer said in the coming year, the organization will assist the medical industry in integrating computer-drive office systems.

It also plans on diversifying its business beyond Medicare by working with insurance companies, foundations and other non-Medicare entities.

“Medicare only accounts for their people, they don’t account for anybody else,” Royer said. “We’re going to be looking toward spreading a lot of the work we’re going to be doing to the non-Medicare population as well.”

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