The Home Health Agency QAPI Program

The new CMS Conditions of Participation (CoPs) for home health agencies are switching things up for home health care providers. As of January 13, 2018, home health agencies have a new set of guidelines they must adhere to in order to be part of the CMS program and be eligible for reimbursement. One of the new CoPs is the establishment of a Quality Assessment and Performance Improvement (QAPI) initiative for home health agencies.

The QAPI program was designed with the goal of achieving more positive outcomes for home care agencies and their patients. The initiative requires HHAs to identify the aspects of patient care or employee performance their agency specifically could improve. By focusing on processes that could be improved, such as employee education, agencies have the opportunity to focus on efforts that benefit their agencies in particular, leading to better care outcomes. Improving patient outcomes should be a priority for all healthcare providers, but with current pay-for-performance measures it is also a necessity to remain financially stable. Thus, while adjusting to the new QAPI standards can be arduous at first, it does benefit both patients and providers in the long run.

QAPI Standards

Many home health agencies look at the new QAPI as a nuisance, and feel that they are too busy to make time for it. But, when executed correctly, the QAPI can actually improve agency processes and make the HHA more efficient on a day-to-day basis. When you look at the various pieces of the QAPI, you can see how they benefit both patients and providers in some ways. Here is a breakdown of the some of the QAPI standards outlined in the new home health agency CoPs:

Program Scope

The program scope for the QAPI states that HHAs must be able to show measurable improvement in certain indicators related to improving patient outcomes, satisfaction, and quality of care. All home health QAPI programs must at least be capable of showing measurable improvements in these specified indicators. In other words, home health agencies are not only required to implement quality improvement plans, but also measure and track indicators of quality improvement. Agencies can design their QAPI programs to meet the needs of their specific HHA, but need to prove that improvement of these indicators will improve quality of care, patient health, and patient outcomes. These quality indicators must include adverse patient events as well as other measures of performance that provide enough context on the quality of the agency’s care, services, and operations.

CMS also requires that there is oversight of the program from a governing body to ensure the QAPI meets certain guidelines such as inclusion of all HHA services in the program, and measures to address prevention and reduction of medical errors. The governing body has their own “executive responsibilities” that also includes addressing any findings of waste or fraud.

Data Collection

QAPI programs must utilize quality indicator data in the development of its program. Additionally, HHAs must collect data on their own program. They can use this data to monitor the quality of their care and services provided, as well as safety measures. They should also use the data to identify any weak spots in their delivery of care that could use improvement. There are no CMS-set rules for the frequency and detail of the data collected; the home health agency’s governing body overseeing their QAPI will approve the HHA’s plan for frequency and detail.

Program Activities

While each HHA designs their own QAPI program, the CoPs outline specifically what types of activities should be implemented as part of the QAPI. Program activity requirements state the performance improvement activities must:

  • Focus on high risk, high volume, and problem prone areas
  • Within those areas, also take incidence, prevalence, and severity of problems into account
  • Immediately correct identified problems that that threaten patient health and safety
  • Track and analyze adverse patient events, and apply preventive measures

Along with conducting their performance improvement activities, HHAs are required to track performance and measure the success of their activities. This must be done continually to ensure that any improvements seen in performance are sustained over time.The CoPs also have a separate standard requiring that home health agencies implement performance improvement projects. They must document the projects they develop, outline their reasons for choosing these projects, and measure and track their success. While the rest of the CoPs came into effect in January 2018, the implementation date for the performance improvement projects is June 2018, so that agencies have sufficient time to prepare and execute the projects.

Adjusting to the New CoPs

The new CoPs change many processes for home health agencies, both on the administrative and patient care sides of the HHA. The QAPI requires home health agencies to continually evaluate their quality of care and make changes accordingly. Most healthcare organizations have been implementing quality improvement measures for ages, so the QAPI should not be anything new. Still, the specific standards and CMS requirements means that many agencies will have to adjust their quality improvement processes and the ways in which they measure and evaluate these programs.

To ensure that you are meeting all of the standards of the QAPI adequately, and putting sufficient time into the program to reap the maximum benefits, consider seeking outside help to manage other aspects of the agency. A firm that specializes in home health agencies can assist you with tasks like billing and accounting while you work towards making changes to comply with the new CoPs. Liberty Consulting can help manage these financial components of your business, so you can focus on your QAPI program and meeting all of the requirements of the Conditions of Participation.

The QAPI may be difficult to adjust to at first, but it really is an important component of a well-run organization. Try to keep the long-term, positive aspects in mind to avoid getting too frustrated as you adjust to the new CoPs. To help ease the stress of directing your HHA, remember to contact Liberty Consulting to get some extra help managing your agency’s billing and accounting needs.

The QAPI program was designed with the goal of achieving more positive outcomes for home care agencies and their patients. The initiative requires HHAs to identify the aspects of patient care or employee performance their agency specifically could improve. By focusing on processes that could be improved, such as employee education, agencies have the opportunity to focus on efforts that benefit their agencies in particular, leading to better care outcomes. Improving patient outcomes should be a priority for all healthcare providers, but with current pay-for-performance measures it is also a necessity to remain financially stable. Thus, while adjusting to the new QAPI standards can be arduous at first, it does benefit both patients and providers in the long run.

QAPI Standards

Many home health agencies look at the new QAPI as a nuisance, and feel that they are too busy to make time for it. But, when executed correctly, the QAPI can actually improve agency processes and make the HHA more efficient on a day-to-day basis. When you look at the various pieces of the QAPI, you can see how they benefit both patients and providers in some ways. Here is a breakdown of the some of the QAPI standards outlined in the new home health agency CoPs:

Program Scope

The program scope for the QAPI states that HHAs must be able to show measurable improvement in certain indicators related to improving patient outcomes, satisfaction, and quality of care. All home health QAPI programs must at least be capable of showing measurable improvements in these specified indicators. In other words, home health agencies are not only required to implement quality improvement plans, but also measure and track indicators of quality improvement. Agencies can design their QAPI programs to meet the needs of their specific HHA, but need to prove that improvement of these indicators will improve quality of care, patient health, and patient outcomes. These quality indicators must include adverse patient events as well as other measures of performance that provide enough context on the quality of the agency’s care, services, and operations. CMS also requires that there is oversight of the program from a governing body to ensure the QAPI meets certain guidelines such as inclusion of all HHA services in the program, and measures to address prevention and reduction of medical errors. The governing body has their own “executive responsibilities” that also includes addressing any findings of waste or fraud.

Data Collection

QAPI programs must utilize quality indicator data in the development of its program. Additionally, HHAs must collect data on their own program. They can use this data to monitor the quality of their care and services provided, as well as safety measures. They should also use the data to identify any weak spots in their delivery of care that could use improvement. There are no CMS-set rules for the frequency and detail of the data collected; the home health agency’s governing body overseeing their QAPI will approve the HHA’s plan for frequency and detail.

Program Activities

While each HHA designs their own QAPI program, the CoPs outline specifically what types of activities should be implemented as part of the QAPI. Program activity requirements state the performance improvement activities must:

  • Focus on high risk, high volume, and problem prone areas
  • Within those areas, also take incidence, prevalence, and severity of problems into account
  • Immediately correct identified problems that that threaten patient health and safety
  • Track and analyze adverse patient events, and apply preventive measures

Along with conducting their performance improvement activities, HHAs are required to track performance and measure the success of their activities. This must be done continually to ensure that any improvements seen in performance are sustained over time. The CoPs also have a separate standard requiring that home health agencies implement performance improvement projects. They must document the projects they develop, outline their reasons for choosing these projects, and measure and track their success. While the rest of the CoPs came into effect in January 2018, the implementation date for the performance improvement projects is June 2018, so that agencies have sufficient time to prepare and execute the projects.

Adjusting to the New CoPs

The new CoPs change many processes for home health agencies, both on the administrative and patient care sides of the HHA. The QAPI requires home health agencies to continually evaluate their quality of care and make changes accordingly. Most healthcare organizations have been implementing quality improvement measures for ages, so the QAPI should not be anything new. Still, the specific standards and CMS requirements means that many agencies will have to adjust their quality improvement processes and the ways in which they measure and evaluate these programs.

To ensure that you are meeting all of the standards of the QAPI adequately, and putting sufficient time into the program to reap the maximum benefits, consider seeking outside help to manage other aspects of the agency. A firm that specializes in home health agencies can assist you with tasks like billing and accounting while you work towards making changes to comply with the new CoPs. Liberty Consulting can help manage these financial components of your business, so you can focus on your QAPI program and meeting all of the requirements of the Conditions of Participation.

The QAPI may be difficult to adjust to at first, but it really is an important component of a well-run organization. Try to keep the long-term, positive aspects in mind to avoid getting too frustrated as you adjust to the new CoPs. To help ease the stress of directing your HHA, remember to contact Liberty Consulting to get some extra help managing your agency’s billing and accounting needs.

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