Education & Training

Get Your Agency Back on the QAPI Track

04/05/2022

The Mother of All Monkey Wrenches, aka the COVID-19 pandemic, threw home care and hospice a huge curve ball. It forced us to focus on infection control and OSHA’s Emergency Temporary Standard. For nearly two years, we were all about hand hygiene and social distancing; finding, donning, and doffing PPE; keeping our patients safe. Departments of Public Health and accrediting bodies put routine surveys on hold.

Now it’s time to document our actions and accomplishments (and address gaps) in ways that uphold our commitment to quality. We must renew efforts to follow the Conditions of Participation (CoPs) and regulatory requirements. These include putting a Quality Assessment and Performance Improvement (QAPI) plan in place. 
What’s your QAPI plan for the year ahead? Where do you start? Keep in mind that per the CoPs, your plan must be approved by your Board of Directors prior to implementation.
 

Getting Started

Begin by reviewing the findings of your most recent accreditation survey. What areas warranted a Plan of Correction? Start with those. Look for the “low hanging fruit” areas of opportunity that can generate the fastest outcomes. Agencies cited for missing HHA supervision should consider asking their skilled nurse to document supervision of HHA during every visit. ​​​​​
 

Procedure Review, Training and Communication

What are the root causes of your agency’s quality scores – good and bad?  QAPI is not just about field staff and OASIS. Take a hard look at your internal processes for Intake and Billing.

Several years ago, agencies noted that their Timely Initiation of Care scores were significantly below state and national averages. Upon review, they discovered their intake departments were not updating Start of Care information when hospital or SNF discharges were postponed. Unfortunately, field staff could not correct those OASIS items (MO102 and MO104) because they were grayed out. Education of the Intake staff promptly corrected that problem. OASIS reviewers were tasked with checking those items as well.
 

Mind Your Data

“You can’t improve what you can’t measure.” Utilize data that you have available to you (reports, results of audits, etc.). Develop a problem statement and develop a plan to address the issue. Garner support from senior management, office, and field staff. Do not take on too many problems at once.

Consider purchasing new data scrubbing programs that allow more real time reports (unlike Care Compare, which could be several years old).
 

Prioritize Your Efforts

Everyone is now dealing with Home Health Value Based Purchasing (HHVBP) and Patient Driven Groupings Model (PDGM, and with the Home Health Consumer Assessment of Providers and Systems (HHCAHPS). 

There are numerous components to HHVBP. Agencies should look at their outcome measures for Improvement in Bathing, Improvement in Ambulation, Improvement in Transferring, and measures related to care of patients and communications.

An entire section of PDGM is devoted to functionality. Look at the overlap with ADL items (as noted above). Targeting some of these will help to improve your agency’s scores. If you have not already done so, consider the interdisciplinary communication between nursing and therapy. Does the therapist concur with the nurse’s responses to OASIS items?

Target some of your outcome measures, provide staff education, and conduct audits to assess your progress.
 

The Holy Grail of Customer Satisfaction

Customer satisfaction is also a popular project. HHCAHPs can provide some of the data for that topic!

Examine your agency’s HHCAHPS scores. Can you improve the response rate? Tell clinicians to remind patients that they may be receiving a survey that asks them specific questions about medications, pain, and home safety. Pay attention to how well each patient rates the agency in the surveys you receive back from them. These numbers are very helpful to your agency’s marketing efforts.
 

All Together Now

Putting together a QAPI plan takes time, planning, analysis, and input from everyone in your home care or hospice agency. If you’re looking for support from a partner that’s been there, connect here with the Corcoran Consulting Group team.