1_AttachmentJ-17MNPrUlcerandPhysRestraint.pdf

Targeted for Improvement in High-risk

Pressure Ulcer Rates

Targeted for Improvement in Physical Restraint

Rates

Provider Number Name

Total # of Beds

(including Non-participating)

City County ZIP Code

X* 245205 ANOKA CARE CENTER 98 ANOKA ANOKA 55303

X* 245535 JOURDAIN/PERPICH EXT CARE FAC 47 REDLAKE BELTRAMI 56671

X* 245599 DIVINE PROVIDENCE COMMUNITY HOME 58 SLEEPY EYE BROWN 56085

X 245510 CRESTVIEW MANOR 42 EVANSVILLE DOUGLAS 56326

X 245292 GOOD SAMARITAN SOCIETY - PRESTON 37 PRESTON FILLMORE 55965

X* 245528 HARMONY HEALTHCARE 43 HARMONY FILLMORE 55939

X 245425 THORNE CREST RETIREMENT CENTER 52 ALBERT LEA FREEBORN 56007

X 245377 PELICAN LAKE HEALTH CARE CENTER 35 ASHBY GRANT 56309

X* 245519 COURAGE RESIDENCE 56 GOLDEN VALLEY HENNEPIN 55422

X 245289 CRYSTAL CARE CENTER 143 CRYSTAL HENNEPIN 55422

X 245279 GOOD SAMARITAN SOCIETY - UNIVERSITY SPECIALTY CARE 205 MINNEAPOLIS HENNEPIN 55414 X 245083 PARK HEALTH AND REHABILITATION CENTER 93 SAINT LOUIS PARK HENNEPIN 55416

X 245271 PROVIDENCE PLACE 211 MINNEAPOLIS HENNEPIN 55407

X 245566 VALLEY VIEW NURSING HOME 45 HOUSTON HOUSTON 55943

X 245367 MEADOW MANOR 43 GRAND MEADOW MOWER 55936

X* 245409 MAPLE MANOR HEALTHCARE & REHAB 81 ROCHESTER OLMSTED 55901

X* 245374 LAKESIDE MEDICAL CENTER 72 PINE CITY PINE 55063

X* 245249 GOOD SAMARITAN SOCIETY - GLENWOOD LAKEVIEW 35 GLENWOOD POPE 56334

X 245537 MINNEWASKA LUTHERAN HOME 72 STARBUCK POPE 56381

X 245097 INFINIA AT FARIBAULT 76 FARIBAULT RICE 55021

X 245383 INFINIA AT OWATONNA 70 OWATONNA STEELE 55060

* = indicates the presence of at least one hospital in the same county

MN Nursing Homes Targeted for Improvement Based on Quality Measure Scores as Calculated by CMS

NOTE: For more information about CMS' quality measures for nursing homes, please visit the Nursing Home Compare tool at http://www.medicare.gov/NHCompare.

The QIO may recruit up to 15% of the total number of providers they will work with from among providers not included in the J-17. The QIO must submit the criteria used to select these providers in their proposal to CMS. In no case may the total number of providers exceed the maximum number of providers as specified in Table B nor may the number of providers not identified in the J-17 exceed 15% of the total number of the providers the QIO recruits to work with.

Provider Number Name City County

ZIP

Code

240115 MERCY HOSPITAL COON RAPIDS ANOKA 55433

240132 UNITY HOSPITAL FRIDLEY ANOKA 55432

240100 NORTH COUNTRY REGIONAL HOSPITAL BEMIDJI BELTRAMI 56601

240206 RED LAKE PHS INDIAN HOSPITAL BEMIDJI BELTRAMI 56601

240083 NEW ULM MEDICAL CENTER NEW ULM BROWN 55073

241327 SLEEPY EYE MUNICIPAL HOSPITAL SLEEPY EYE BROWN 56085

241352 SPRINGFIELD MEDICAL CENTER SPRINGFIELD BROWN 56087

240105 COMMUNITY MEMORIAL HOSPITAL SPRING VALLEY FILLMORE 55975

240150 HARMONY COMMUNITY HOSPITAL ASSN INC HARMONY FILLMORE 55939

240057 ABBOTT NORTHWESTERN HOSPITAL MINNEAPOLIS HENNEPIN 55407

240078 FAIRVIEW SOUTHDALE HOSPITAL EDINA HENNEPIN 55435

240004 HENNEPIN COUNTY MEDICAL CENTER MINNEAPOLIS HENNEPIN 55415

240053 METHODIST HOSPITAL ST. LOUIS PARK HENNEPIN 55440

240001 NORTH MEMORIAL HEALTH CARE ROBBINSDALE HENNEPIN 55422

240196 PHILLIPS EYE INSTITUTE MINNEAPOLIS HENNEPIN 55404

240080 UNIVERSITY OF MINNESOTA MEDICAL CTR MINNEAPOLIS HENNEPIN 55426

240006 OLMSTED MEDICAL CENTER ROCHESTER OLMSTED 55904

240061 ROCHESTER METHODIST HOSPITAL ROCHESTER OLMSTED 55902

240010 SAINT MARYS HOSPITAL ROCHESTER OLMSTED 55902

240211 LAKESIDE MEDICAL CENTER INC PINE CITY PINE 55063

241309 PINE MEDICAL CENTER SANDSTONE PINE 55072

241376 GLACIAL RIDGE HOSPITAL GLENWOOD POPE 56334

241310 WESTERN POPE COUNTY HOSPITAL STARBUCK POPE 56381

MN Hospitals Located in Counties with Nursing Homes that Are Targeted for Improvement in High-Risk Pressure Ulcer Rates

Based on Quality Measure Scores as Calculated by CMS

The QIO may recruit up to 15% of the total number of providers they will work with from among providers not included in the J-17. The QIO must submit the criteria used to select these providers in their proposal to CMS. In no case may the total number of providers exceed the maximum number of providers as specified in Table B nor may the number of providers not identified in the J-17 exceed 15% of the total number of the providers the QIO recruits to work with.