White Paper Helps Understanding of Home Health QAPI Initiatives

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By Diane Link, RN 
Senior Clinical Consulting Manager, BlackTree Healthcare Consulting
Prepare for the Transition to QAPI

Mandated quality improvement programs are coming to home health as part of the Conditions of Participation (CoPs) final rule published in the Federal Register in January 2017. The rules go into effect January 13, 2018, and home health organizations have until July 2018 to begin initial quality improvement projects.

But that doesn’t mean your organization shouldn’t be looking closely at the new regulations and formulating an action plan now. To help your organization begin the planning process, download our new white paper, “Understanding the Quality Assurance and Performance Improvement Program Revisions to the Home Health Conditions of Participation.”

The white paper distills 88 pages of regulation into some basic components to help you better understand some of the requirements. It also includes concrete steps you can be taking now to prepare.

More patient-centered care the goal

The updated home health CoPs are designed to develop a more patient-centered, interdisciplinary approach to patient care, while eliminating some of the administrative process requirements currently in place. One of the major changes in the revised CoPs is the new requirement to develop an organizational-wide, data-driven Quality Assurance and Performance Improvement (QAPI) program.

Implementing a data-focused QAPI program that monitors organizational-wide data can provide you an opportunity to proactively identify issues and develop improvement plans that can help set up your organization for success.

The rule organizes the QAPI CoPs into five standards:

  • Program scope
  • Program data
  • Program activities
  • Performance improvement projects
  • Executive responsibilities

Home health organizations are responsible for developing the QAPI program scope, including indicators that impact health outcomes, can be measured and resonate throughout the organization. Monitoring and maintaining patient safety are of critical importance at each step of the process.

Internal and external benchmarking can help organizations develop baseline measurements and set improvement goals. External benchmarks are available through CMS reports, benchmarking services, consulting companies or state and national home health associations. Internal benchmarks would be goals set by the organization based upon prior performance, and/or expected improvement scores.

High risk patient, regulatory and billing practices targeted

QAPI program activities can focus on data points as well as high risk, high volume problem areas that require continual monitoring. Examples include falls with or without injuries, medication reconciliation issues, delay in care or acute care hospitalizations. Certain regulatory requirements are considered high risk, including development of the plan of care, physician orders, clinician licensures and patient rights. Billing requirements considered high risk include face-to-face documentation, certification of Medicare eligibility and patient right to know financial responsibility. Organizations should also note high volume problem areas that can be noted across the patient population such as diagnosis or length of stay.

Performance improvement projects (PIPs) identified and initiated after organizational analysis should be formal in nature, with written documentation that outlines the reason for the project and the supporting data. It should include the project owner, project leaders and other members.

The PIP committee should provide executive summary reports to the quality committee, professional advisory committee and the governing body. The committee should be in communication with senior leadership to determine the preference for frequency and type of report.

QAPI requirements contained in the Home Health Conditions of Participation represent a formal, step-by-step approach to quality improvement. Learn more when you download our new white paper, “Understanding the Quality Assurance and Performance Improvement Program Revisions to the Home Health Conditions of Participation.”

The information provided in this Change Healthcare site is provided to you for informational purposes only. The materials are general in nature, are not offered to you as advice on a particular matter, and should not be relied on as such. Use of this web site does not constitute a legal contract or consulting relationship between Change Healthcare and you.

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