Lucky we live Hawai‘i isn’t just an expression about the place we call home; these are words to live by. For seniors enjoying their golden years, this is an age of prosperity, good health, and long life.

As the Medicare Quality Improvement Organization for Hawaii, Mountain-Pacific Quality Health believes this too, because quality of care means a better quality of life.

‘Ohana means family, and here in Hawaii, we represent a huge ‘ohana, because we take care of each other, we help one another. One of the perks Medicare gives beneficiaries and their families is the quality improvement organization, and we’re here to help in any way we can.

Our goal is simple: to make sure that Medicare beneficiaries receive the very best medical care.
Doctors and health care providers want to give the very best care to their patients. However, since doctors are human and people run hospitals, neither is perfect. If you believe a Medicare provider may have placed your health at risk, by voicing your concern, you help make future patient care better.

You can also make a difference. If you are a Medicare beneficiary and are troubled by the quality of the health care you have received, call Mountain-Pacific. We will ask you to send your concern in writing, because we want to make sure nothing is missed or misunderstood.

If your concern is medical, Mountain-Pacific’s staff obtains a copy of your medical record and reviews it closely. When we do a medical record review, we ask your doctor or healthcare provider to mail us a copy of your medical record. The purpose of the review is not to punish the doctor or provider; it is to help doctors and healthcare providers improve the care they give in the future.

Next, a Mountain-Pacific review doctor reads your chart to see if it shows that your care was at professionally recognized standards. Our review is based only on what is written in your medical record; the doctor who reviews your record does not have a relationship with your doctor or the facility where your care was provided. The review process could take several months.

If your chart shows that your care was below the accepted standard, we talk with your medical provider about what happened. Providers include doctors, hospitals, nursing homes and home health agencies. Mountain-Pacific works with your provider to find the cause of the problem and decide what changes need to be made. Over time, we continue to work with your provider to make sure medical care is improved in the future.

If you are hospitalized, the hospital determines the type of services your medical attention requires. If Medicare does not cover these services, you will be notified by the hospital. However, if you disagree with the hospital’s determination, you have the right to appeal the hospital’s decision.

If your concern did not result from harm, mediation is an option. Misunderstandings and poor communication are often the cause of healthcare concerns. Mediation brings you together with a doctor, hospital or other healthcare provider by phone or in-person contact, in a meeting led by a mediator.

We also help in other ways. Mountain-Pacific collaborates with hospitals and physicians to implement the best treatments for conditions that often effect older adults, such as heart disease, diabetes and pneumonia. We also work to make sure that those undergoing surgery are given the best antibiotic therapies known to prevent infections.

Mountain-Pacific helps nursing homes improve quality of care, reduce staff turnover, and create more home-like environments for their residents. We also work with home health agencies to improve patient health and well-being. And by promoting the use of electronic health records, providers have ready knowledge of their patients’ history and special needs.

In addition, seniors are encouraged to learn about and use important preventive health services covered by Medicare. These include annual screening mammograms, annual flu shots, pneumonia shots, and regular foot exams and dilated eye exams for people with diabetes.

The best years of your life should be filled with options, choices and peace of mind. We can help, because Mountain-Pacific envisions a healthcare system where every person receives the right care, every time. There are proven best practices that can make this vision a reality.

Our staff can help transform the way care is delivered. To find out how, call us at 545-2550 or 1-800-524-6550, or visit us online at www.mpqhf.org.

Dee Dee Nelson is Hawaii Director of Mountain-Pacific Quality Health.