What is QAPI in Home Health?
Most of the time, when people hear the word QAPI, they usually roll their eyes, grumble under their breath, or go glassy eyed and remember therapy recently completed therapy sessions. QAPI is something in home health that people don't really like to do, but have to do it.
So, what is it? QAPI means Quality Assessment and Performance Improvement. QAPI is required for home health agencies as a condition of participation. It is listed as this in the link for conditions of participation.
484.65 Condition of participation: Quality assessment and performance improvement (QAPI). You can read all about reading the Conditions of Participation. It is some light reading.
One of the biggest headaches we hear about is QAPI. It is the job no one really wants to do, has to get done, and is easily overwhelming.
What are the 5 Elements of QAPI?
Here is the text of the introduction for QAPI from the CMS website. Develop, implement, evaluate, and maintain are just some of the words. Not only does it have to be on going, but it has to be data driven. Here is what it says:
"The HHA must develop, implement, evaluate, and maintain an effective, ongoing, HHA-wide, data-driven QAPI program. The HHA's governing body must ensure that the program reflects the complexity of its organization and services; involves all HHA services (including those services provided under contract or arrangement); focuses on indicators related to improved outcomes, including the use of emergent care services, hospital admissions and re-admissions; and takes actions that address the HHA's performance across the spectrum of care, including the prevention and reduction of medical errors. The HHA must maintain documentary evidence of its QAPI program and be able to demonstrate its operation to CMS." But wait, there's more:
Here are the 5 Standards of QAPI per the Conditions of Participation (COPs).
We will briefly go over these 5 things, and then offer some suggestions on how we can help with some of these elements.
An Agency's QAPI program needs to show measurable indicators and that those indicators will improve outcomes, patient safety, and quality of care. Basically, it's saying that you have to measure something that is measurable and helpful to patients and the agency. Agencies then need to be able to track certain quality indicators "including adverse patient events" and other key indicators that shows that an agency is trying to and tracking improvement in outcomes and operations.
Agencies need to use OASIS driven data, along with other relevent data, to track the indicators in designing the QAPI program. The agency then needs to actually do something with the data that can track and monitor the effectiveness of the QAPI program and identifies areas of improvement.
QAPI must focus on the high risk, high volume, or problem prone areas. Agencies need to be able to understand the what, where, how, how much and how often, and why of operational challenges that could impact patient health and safety. These activities need to track adverse patient events and then find out what and how those events happened, and then put corrective action plans in place so those things can be eliminated or avoided in the future. "The HHA must take actions aimed at performance improvement, and, after implementing those actions, the HHA must measure its success and track performance to ensure that improvements are sustained."
Performance Improvement Projects
Agencies must now do something about the areas of improvement that have been identified and track them. These projects need to reflect the complexity of the agency, document the projects undertaken, why they were undertaken, and the measurable progress achieved from the projects.
Home health leadership must be involved in the QAPI program and its oversite. Management needs to make sure that the program is defined, implemented, and maintained. It needs to be managed by managers! Further management needs to set priorities for QAPI and its efforts to improve the quality of care, patient safety, operational excellence, and that the improvement actions are evaluated. If any fraud or waste is discovered, then it needs to be immediately addressed and corrected.
What is a QAPI Plan?
Home Care Answers not only provides quality service through coding and OASIS review to ensure OASIS is correct, we also provide data analytics to help agencies improve. We provide you with your own data in a way that you can do something with it! Agencies need to use OASIS driven data for the QAPI program. Do agencies know and understand what OASIS questions are most frequently answered incorrectly? Do they know that by Clinician? Well, we can help! Below, you will see a chart that shows an agency that recently signed on to work with us. We provide data analytics for several groups of OASIS questions. Below, you can see what ADL questions we are suggesting changes on the most often.