CIMRO’s business planning retreat this year was focused on growth.  At the end of our retreat, the entire team was provided with mini grow pots and flower starter kits.  The results have turned out as expected.  Numerous seeds have been planted and re-planted and only a select few have actually grown or survived. 

​We’ve seen excitement,  and some impatience, from germination to sprout.  Seedlings brought joy and later disappointment when they didn’t continue to grow as expected.  A select few have reached the plant stage, which made us wonder if there is/was a secret to success and if they would actually reach the bloom stage.    

April Vogelsang, RN, MS, NEA-BC
​Chief Executive Officer
[email protected] 

PRs who review cases routinely for CIMRO – and those who are brand new – will be familiar with receiving “PR Monitoring” e-mails periodically.

The letters are meant to be constructive and a resource to use in writing even better reports in the future. They contain “yes/no/not applicable” responses to six standard questions regarding things such as whether all sections of the worksheet were completed, whether each determination was supported adequately, and whether the time spent in review was reasonable. That’s followed by a brief summary of the case reviewed and individual feedback for the peer reviewer.

As chief medical officer, I review all independent review organization (IRO) insurance reviews,  a sampling of peer-review reports,  and  any reports that have generated questions or complaints. Elements I take into account when monitoring a report:

• Did the client or CIMRO staff raise specific questions or concerns about the review? All of these cases will be chosen for monitoring.
• Did the reviewer answer all the questions asked? Answers should be comprehensive, and the rationale for each should be clearly stated.
• Is the review educational and professional? Clients and departments of insurance need comprehensive education and recommendations for future practice. That is why peer review needs to be an honest, independent evaluation of all aspects of care.
• Is the review supported by appropriate, current literature? Each IRO report must contain at least one reference article, and reviewers are highly encouraged to include supporting literature in every report they write, if possible. Not every case lends itself to having references, but those should be the minority.

We appreciate the PRs who have taken our guidance to heart and used it to improve as reviewers. One case that stands out from this year was a PR who went so far as to rewrite a report to put it in a more narrative, comprehensive form that paints a clear picture for the client of what went well, what went wrong, and what can be changed for future improvement.

While these principles of monitoring will remain the same in the new year and beyond, the format of the letters will change. Salesforce will streamline the process on our end – we’re retiring a clunky  system that is far past its prime – and hopefully make the feedback more meaningful for reviewers.

Finally, please contact us if you have questions about a monitoring letter you have received, or if you need any guidance in the process. You are a valuable resource to clients looking to improve quality of care, and we want to support you in your endeavors however we can. 

Project and Compliance Manager Cindy Scopel, RN, retired on December 31st - 11 years after joining the team as a review coordinator.

From writing and editing reports, to processing the invoices and signing the checks, to ensuring compliance with regulations and maintaining CIMRO’s excellent ratings with its accrediting organization – in addition to putting out the fires that seem to crop up daily – Cindy has done it all.
 
After a stint as review coordinator, she was named assistant project manager in July 2014. Before the year was out, she added corporate compliance manager to her credentials. In October 2015, she was named project manager for review programs. And in March 2017, she absorbed more duties with operations and business development.
 
But beyond the facts and figures, Cindy has brought with her every day a sense of collegiality and humor that gives a lift to the workplace.
 
Incoming Project Manager Lori Fossier said she’ll miss chatting with Cindy, exchanging recipes and favorite foods, and sharing family photos.
 
The same welcoming personality, coupled with years of expertise and experience, served her well with CIMRO’s reviewers and clients present and future. More often than not, any business call began with Cindy making connections to the people on the other end of the line. At the very least, she’d know that person’s hometown, something about their family, or what the weather was doing there.
 
“I’ve always said that Cindy’s super power was being able to talk to anyone, any place, any time, about anything,” co-worker and review coordinator Marge Donoghue said.
And if that “anyone” is from Central Illinois, chances are good that Cindy already knows them.

Before coming to CIMRO, she spent 36 years in nursing, much of that at a local hospital that also is one of the area’s largest employers. She and her husband raised their two daughters in the community, as well.

Lori said she’s grateful for Cindy graciously sharing her knowledge and experience, making it easier to transition into her new role.
 
We’re all also grateful that Cindy has agreed to stay with CIMRO to work on an “as-needed” basis.
We’re not sure what she’ll consider “needed,” though. She already has her first trip to Florida to spend time with her older daughter, son-in-law, and two granddaughters scheduled for mid-January. And her younger daughter will keep her busy starting in the spring with her new grandson.
 
Longtime peer reviewer Barry Uretsky wishes Cindy the best in those next adventures.
“I am sorry to hear Cindy is retiring. She has always been a pleasure to work with to produce the highest-quality peer review reports.”
 
And Assistant Project Manager Rita Taylor summed it up for all of us:
“She’s going to be missed a LOT, and she’s been wonderful to work with!”

Lori Fossier joined CIMRO as a review coordinator on May 27, and was named project manager on Dec. 1, taking over for Cindy Scopel, who retired at the end of the year.  It has been a crash course in learning one new role, and then another.
 
Lori has been a registered nurse for 32 years. She began her career as a pediatric nurse in St. Louis, then went on to work as a nurse at a law firm. Her experience also includes risk management, care coordination and quality. Most recently, she was director of utilization management for a health plan.

Asked if she has been surprised by anything at CIMRO, Lori mentioned the office is very quiet. The busyness certainly keeps us busy.
 
Lori is married with two adult children, and lives in Champaign, home to her alma mater, the University of Illinois (there’s a lot of orange and blue at CIMRO – almost everyone in the review department has attended the U of I).
 
Asked for anything fun/funny/quirky to share, Lori related the following story that shows how small of a world it really is:
 
Recently, I had the opportunity to travel to Ferentino, Italy, the ancestral city of my paternal great-grandfather.  Ferentino is an ancient city about an hour south of Rome and is a sister city to my hometown of Rockford, IL.  Contacts in my hometown coordinated a host to meet us in Ferentino.  Our host spent the day showing us the city and to our surprise, she located long-lost cousins and arranged a luncheon for us to meet them!

Gideon Onwodi joined CIMRO as a review coordinator in September. He comes well-qualified with a bachelor’s degree in interdisciplinary health and a master’s in public health from the University of Illinois.
 
Gideon is quickly building connections and contributing to the review process, both in receiving requests for review from clients and assigning them to reviewers, and in preparing reviewers’ work and submitting completed reports to our clients. Learning the complexities of all the different services CIMRO offers has been a challenge, he said.
 
Gideon came to CIMRO from a health plan, where he was a quality improvement coordinator. Prior to that, he coordinated care for the Medicaid population. He also has been a healthcare navigator, assisting patients with community resources, getting established with primary care, addressing social-based needs, etc. 
 
Gideon was born and raised in Nigeria, and moved to the United States in  1999. He speaks two languages, and has learned some Spanish and French. The French has been mostly forgotten, he said, except that he can still count up to 100 – “maybe a thousand if I really need to.”
Gideon and his wife have two little ones at home – a 4-year-old daughter and a 2-year-old son. ​

As an organization focused on quality, we’re continuously improving our services. In 2024, our clients shared positive feedback with us through our New Client Surveys or informally, through email.

“We were very pleased with CIMRO and the physician peer review. Our request for an expedited review was honored and returned within our needed timeframe. We very much appreciate the willingness of Cynthia Scopel and the physician peer reviewer to answer side questions that we had in addition to the formal review questions. This was very helpful. Cynthia was also very responsive, very professional yet friendly and accommodating. Overall this was a positive experience and we will definitely use CIMRO again for Physician Peer Review. Thank you.”

Regarding our new client portal:  “I thought the portal was great. Very easy to use. “

Regarding our new client portal:  “I like it-nice, seems easy to navigate.”

“I cannot say enough about having external, unbiased, board-certified professionals who can provide this level of expertise.” 

We have transitioned to completing 100% of our reviews within our new Peer Review portal, a Salesforce-based platform. Thank you to those reviewers who have already completed reviews in the portal as well as those who have given us feedback about what works well and where we can improve! We have reviewed all these comments. Some suggestions we have already been able to incorporate; we will continue to work on integrating as many suggestions as possible during future upgrades. We appreciate everyone’s patience and willingness during this transition process…it’s been a learning curve for all of us!

Peer Reviewer feedback on the new Peer Review portal
“It was fairly intuitive. The instruction on how to use the system on each page was helpful.”
​
“The new system was very intuitive. Didn’t have any problems logging in or filling out the questions. My only concern is the 4500 characters for the summary… It would be great if there was some ability to dictate rather than type but that’s just my preference. Overall I like it, great job and excellent implementation.”

Tips and Tricks

• When your account is first enabled in the review portal, you need to finish setting up your account within 7 days
• View the video prior to your first case review to get an overview of how the portal works
• Save your work frequently
• Do not use the back button at the top of the screen unless you have saved your current work, as this could delete any unsaved work
• Download medical records…the Preview button only allows you to see the first 100 pages of the document
• Each case summary and answer Status needs to be marked as Complete as you finish with them
• Once all cases within a Case Group have been completed, you need to Submit the Case Group back to CIMRO
• Any Case Groups that show on your main screen are still active and have not been submitted

​Virtual assistants like Amazon Alexa, Google Assistant, and Apple Siri are becoming increasingly common in homes and offices. While they offer convenience and efficiency, their presence in settings where patient information is discussed raises significant security and privacy concerns. These devices are designed to listen for voice commands, which means they may inadvertently capture sensitive conversations, including those involving patient health information. Data collected by virtual assistants is often stored in the cloud, where it could be accessed by unauthorized parties or exposed in the event of a breach.
 
HIPAA regulations mandate stringent protections for any device or service handling Protected Health Information (PHI), but consumer-grade virtual assistants are not HIPAA-compliant. They lack necessary safeguards like robust encryption and mechanisms to fully delete stored data, and they do not allow for Business Associate Agreements (BAAs), which are essential for HIPAA compliance. To mitigate risks, healthcare providers and peer reviewers should avoid using these devices in sensitive areas, disable microphones during private discussions, and educate staff about the importance of maintaining patient confidentiality.

In August 2024, URAC provided notice to CIMRO of FULL Accreditation pursuant to the Independent Review Organization (IRO), External Review 6.0 Program, for the maximum three-year period (September 1, 2024, to September 1, 2027).
Notably CIMRO has been URAC accredited for more than 20 years.  We were first accredited by URAC from 2001 to 2009 as a Health Utilization Management (HUM) organization, and then as an IRO since 2009. 
​
The rigor of the accreditation process confirms our processes meet industry best practices.  
Physician reviewers involved in IRO reviews must have at least 5 years’ experience providing direct clinical care to patients and managing the medical condition, procedure, treatment, or issue under review within the past 3 years. 
​
IRO services are provided to state departments of insurance and health and self-funded plans for member appeals of health care services that have exhausted the health plan's internal appeals processes, including denials due to:

• Medical necessity 
• Experimental/investigational
• Pre-existing condition/rescission of health coverage

A frequent question related to liability protection arises in conjunction with peer review activities.  The Health Care Quality Improvement Act of 1986 (HCQIA) provides good-faith immunity from state and federal liability for people participating in the peer review process.
 
CIMRO's contracts with our clients specifically address the fact that our PR decisions are considered part of internal quality improvement processes, which further affirms the protections afforded under HCQIA.
 
CIMRO also maintains a professional liability policy, which extends coverage to peer reviewers performing services for CIMRO. The Errors & Omissions policy has limits of $4 million per claim and $4 million in aggregate. This legal protection covers all peer reviewers, CIMRO staff and board members carrying out peer review responsibilities. 
 
CIMRO can compile and provide relevant sections from its policy upon request.   

This notice serves as a reminder that the Certification and Acceptance statements you previously signed remain in full force and effect. You have agreed to abide by the letter and spirit of CIMRO’s Confidentiality Policy, Conflict of Interest Policy, and Code of Business Conduct.  You also acknowledged your understanding and agreement that any failure to fully comply with the letter and spirit of the Code, including any related confidentiality and/or conflict of interest activities and their reporting requirements, will be grounds for immediate termination of employment, subcontract, other contractual relationship or removal from the Board of Directors, as the case may be.
 
In accordance with CIMRO’s Enterprise Compliance Program, the Board of Directors has mandated an annual reminder notice of our Confidentiality-Security Policy, Conflict of Interest Policy, and Code of Business Conduct requirements:  1) to emphasize the confidential nature of the services provided by CIMRO, 2) to emphasize the importance of identification and disclosure of conflict of interest, and 3) as part of our ongoing commitment and belief that compliance to these is a shared responsibility.
 
Certification and Acceptance statements signed by you are on file at CIMRO regarding your review and acceptance of CIMRO’s Confidentiality Policy, Conflict of Interest Policy, and Code of Business Conduct and awareness of your obligation to comply with and report actual or suspected violations of the Code, which includes all confidentiality and conflict of interest requirements. This obligation is a condition of employment or a relationship with CIMRO. 
 
Please understand that you are conclusively deemed to have ratified your certification and acceptance unless, within 10 business days of the date hereof, you withdraw that certification and acceptance by written notice received by CIMRO within that 10-day period.
 
If you are unable to locate your copy of the Confidentiality Policy, Conflict of Interest Policy, or Code of Business Conduct, you may call 1.800.635.9407 to speak with the Compliance Manager to request another copy. You may also view the Code of Business Conduct on our website.