Performance-based reimbursement requires an efficient approach to documentation and data collection. Between readmission penalties and the IMPACT Act of 2014, the data we use to demonstrate quality outcomes is quickly becoming the currency of our business. Success in the changing reimbursement models means we need to take a data-driven, proactive approach to improving care and quality of life in nursing homes.
The Affordable Care Act of 2010 resulted in a provision to develop standards we now know as “QAPI” programs or Quality Assurance & Performance Improvement programs.
QAPI is the foundation.
There are five elements to a strong QAPI program that follow the Plan-Do-Study-Act format:
- Design and scope.
- Governance and leadership.
- Feedback, data systems and monitoring.
- Performance improvement projects (PIPs).
- Systematic analysis and systematic action.
Design and scope.
In the design and scope phase we need to carefully study areas that are not meeting expectations. Data should be used to help identify problems and opportunities for improvement. We need to be specific in the design of the program such that it targets an identified issue. The entire quality improvement plan needs to be comprehensive and inclusive of all departments.
One example might be hospital transfers. Do we have tools to help us examine trends in hospital transfers that could be avoided? Can we look at certain days and shifts during which the transfers are taking place? Are they always happening on Saturday evenings? Is there an opportunity to redesign the staffing model to reduce the number of avoidable transfers?
Governance and leadership.
A QAPI program has the strongest impact and rate of success when led from the top and fosters a culture focused on improvement.
As with anything, the program needs to have adequate funding and resource allocation. Input from key stakeholders is often undervalued and therefore overlooked. It shouldn’t be. Seek input from staff, families and residents when drafting a program. This will help you prioritize areas for improvement and may shed light on issues you weren’t aware of while balancing improvements with resident-centered rights and choices.
Feedback, data systems, and monitoring.
So, how do we collect data that can be used? The most important thing to ensure is that we have systems in place to help us monitor care. Does our electronic health record (EHR) system assist in monitoring care and quality outcomes? We also need to make sure we’re collecting information from multiple sources. A baseline needs to be identified so improvement can be routinely measured against established benchmarks or internal baselines. The system for monitoring must also track adverse events.
Performance improvement projects.
A performance improvement project, or PIP, should follow the Plan-Do-Study-Act cycle. It should concentrate on a specific problem. Information should be systematically collected to clarify the issue and identify opportunities for improvement, using quality improvement tools to perform root cause analysis.
Systematic analysis and systematic action.
Lastly, the analysis and action should provide a structured approach to determining the cause(s) of the identified problem and evaluate the results of interventions.
Going back to our example of hospital transfers, we might benefit from looking at data relative to resident characteristics on those that were transferred out. We could look at the resident condition, age and past hospital transfers to evaluate what the root cause might be in triggering a need for transfer. Do we have an opportunity to improve any aspect of the care that would reduce the need for transfer?
The process improvement loop can help be used to help facilitate discussion while developing your QAPI program. By following these five steps, your staff will be on the right track to developing a measurable and actionable plan.
There are many ways to approach planning for quality improvement. CMS offers several resources and tools to help guide providers in developing a program. (http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/qapitools.html) In addition to tools and resources, CMS provides a description and background on what QAPI is and how it came about.
On Demand Webinar – Quality is the New Currency: Four Ways to Improve your QAPI Program Today.
With changes to the Five-Star Rating system and the looming impact of the IMPACT Act of 2014, quality is top of mind for every long-term care provider in the country. While there are no hard and fast rules for development of a solid QAPI program, there are some things you can implement to ensure you’re covering the necessary areas.
View this 30-minute webinar where you will learn four things you can do to strengthen your QAPI program right away.
About the Author
Janelle Miller, RN, MBA, Senior Product Manager
Janelle is currently the Clinical Product Line Manager at PointClickCare. Prior to this, she had a forty-year career in nursing and worked in many specialty areas including med-surg, renal dialysis, pediatric intensive care, reproductive endocrinology and home health. Janelle spent a large portion of her career working in quality improvement in both the hospital and in-home health. As well, she served as the Executive Director of the American College of Medical Quality for three years. For the past fifteen years Janelle has been working with computer application design and clinical content development. She has worked in multiple areas, most recently in the managed care arena, for Milliman Care Guidelines and Blue Cross Blue Shield of Massachusetts.