Effective QAPI – 3 Important Concepts to Keep in Mind

This content was originally published on June 14, 2018

How does an agency create an effective QAPI? McBee crafted three important points to keep in mind. “… QAPI amounts to much more than a provision in Federal statute or regulation; it represents an ongoing, organized method of doing business to achieve optimum results, involving all levels of an organization.” CMS.gov

Quality Assurance Performance Improvement (QAPI) programs are not just another regulation and they are not aimed at giving your agency a giant headache. Implemented correctly, effective QAPI can be useful to improve your agency outcomes and finances. It can better define your bottom line and increase your agency’s ability to provide quality care effectively and efficiently. QAPI is already mandated by CMS and should be in place in every agency across the country.

McBee experts have outlined three major effective QAPI concepts that we recommend you remember above all.

Be Realistic – Effective QAPI Concept 1

Agencies need at least one performance improvement project active and in process at all times. It is tempting to shoot for the stars and create a project that aims to fix every problem at every level but consider your limitations. Is this a realistic goal? Will this work for my agency and can I complete it?

Spend time plotting out the steps for improvement before you commit to the plan

Find the data and determine the benchmarks that you will need to show that improvement was made

Be Reflective – Effective QAPI Concept 2

QAPI must “reflect the complexity of your organization”. Therefore, the more complex the organization, the more complex the QAPI program. When deciding how complex the program should be, take into consideration your agency’s population, average reasons for admission, and geographic area as well as other factors specific to your agency.

Each Performance Improvement Project (PIP) is unique to the agency and as unique as the agency:
Large healthcare systems with many high acuity patients cannot propose a low-level hand-washing PIP and claim that they are indeed following the guidelines and working toward an overall effective QAPI.

A small, local agency with a patient census of 25 and no EMR is not expected to create a PIP based on complicated analytics.
The complexity and appropriateness of the QAPI program are up to the interpretation of the surveyors. Be sure that your PIPs make sense to your agency. You must support and back-up the reasoning for that PIP with data and a plan for how it will improve the quality of your agency.

Be Retroactive and Proactive – Effective QAPI Concept 3

It is best to conceptualize effective QAPI as two linked parts. Quality Assessment (QA) is retroactive. For QA, look at what happened before and work to understand it. Rather, Performance Improvement (PI) is more proactive. For PI, determine how your agency is going to change the approach, workflows, or processes to prevent reoccurrence of these particular challenges.

Remember agencies can not just simply use clinical (such as chart review) for PIP every single time. Other projects might include reviews of personnel records or financial assessment of days to RAP/final billing.

For example – Upon review, you find there is often no history and physical in charts
Ask: Why – what’s going on with the referral?
Could this be a broken process with the marketing team? With the intake process? Is there a lack of education/understanding of requirements?
Record benchmarks and follow data points so that you can see and show improvement. The PIP must be measurable.
Plan education to address the pain points
Create the change