1_AttachmentJ-17NVPrUlcerandPhysRestraint.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 295023 CARSON CONVALESCENT CENTER 73 CARSON CITY CARSON CITY 89701

X 295067 EVERGREEN AT CC HEALTH & REHAB 120 CARSON CITY CARSON CITY 89703

X 295079 EVERGREEN MOUNTAINVIEW HEALTH 146 CARSON CITY CARSON CITY 89701

X 295085 HIGHLAND MANOR OF FALLON 102 FALLON CHURCHILL 89406

X 295041 DELMAR GARDENS OF GREEN VALLEY 242 HENDERSON CLARK 89014

X 295008 EL JEN CONVALESCENT HOSP SNF 144 LAS VEGAS CLARK 89130

X* 295052 LIFE CARE CENTER OF LAS VEGAS 239 LAS VEGAS CLARK 89108

X* X 295073 MANOR HEALTH CARE CENTER 225 LAS VEGAS CLARK 89134

X* 295040 ST JOSEPH TRANSITIONAL REHABILITATION CENTER 100 LAS VEGAS CLARK 89102

X* 295082 EVERGREEN GARDNERVILLE HEALTH & REHAB CTR 60 GARDNERVILLE DOUGLAS 89410

X 295078 HIGHLAND MANOR OF ELKO 112 ELKO ELKO 89801

X* 295024 HARMONY MANOR HGH SNF 30 WINNEMUCCA HUMBOLDT 89445

X* 295075 EVERGREEN AT PAHRUMP HEALTH & 120 PAHRUMP NYE 89048

X 295015 NYE REGIONAL MED CTR SNF 30 TONOPAH NYE 89049

X 295000 PERSHING GENERAL HOSPITAL SNF 30 LOVELOCK PERSHING 89419

X 295050 LIFE CARE CENTER OF RENO 198 RENO WASHOE 89511

X 295043 MANOR CARE HEALTH SERVICES 189 RENO WASHOE 89509

X 295034 RENOWN SKILLED NURSING 160 SPARKS WASHOE 89431

X 295020 ROSEWOOD REHABILITATION CENTER 99 RENO WASHOE 89512

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

NV 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

290010 BOULDER CITY HOSPITAL BOULDER CITY CLARK 89005

290022 DESERT SPRING HOSPITAL LAS VEGAS CLARK 89119

290042 HARMON MEDICAL AND REHAB CTR LAS VEGAS CLARK 89119

290036 IHS OF SHADOW MOUNTAIN LAS VEGAS CLARK 89130

291307 MESA VIEW REGIONAL HOSPITAL MESQUITE CLARK 89027

290039 MOUNTAINVIEW HOSPITAL LAS VEGAS CLARK 89128

290005 NORTH VISTA HOSPITAL NORTH LAS VEGAS CLARK 89030

290044 PROGRESSIVE HOSPITAL LLC LAS VEGAS CLARK 89121

290047 SOUTHERN HILLS HOSPITAL & MEDICAL CT LAS VEGAS CLARK 89148

290046 SPRING VALLEY HOSPITAL LAS VEGA CLARK 89118

290012 ST ROSE DOMINICAN - DELIMA HENDERSON CLARK 89015

290045 ST ROSE DOMINICAN - SIENA HENDERSON CLARK 89052

290041 SUMMERLIN HOSPITAL MEDICAL CTR LAS VEGAS CLARK 89144

290003 SUNRISE HOSPITAL LAS VEGAS CLARK 89109

290007 UNIVERSITY MEDICAL CENTER LAS VEGAS CLARK 89102

290021 VALLEY HOSPITAL MEDICAL CENTER LAS VEGAS CLARK 89106

291306 CARSON VALLEY MEDICAL CENTER GARDNERVILLE DOUGLAS 89410

291308 HUMBOLDT GENERAL HOSPITAL WINNEMUCCA HUMBOLDT 89445

290052 DESERT VIEW REGIONAL MEDICAL CENTER PAHRUMP NYE 89048

290020 NYE REGIONAL MEDICAL CENTER TONOPAH NYE 89049

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

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.