Long-term care rules and regulations have been changing at a fast and furious pace over the past few years. Often, changes can happen so quickly that it can be nearly impossible to train staff and update processes in time to stay current. We have seen this burden play out across all senior living facilities (SNFs), from independent homes to small and large chains alike.
This case study illustrates how one facility discovered how to utilize QAPI processes to overcome their specific ADL and customer satisfaction challenges.
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Sunny Cove Nursing Home was informed by the state ombudsman that they had a reputation for discharging residents who have been unhappy with their care and overall outcomes. To address this, Jane Doe, DON, had her administrative nurses begin an investigation to determine if this allegation was credible.
Setting your goals is a vital part of the Quality Assurance/ Performance Improvement (QAPI) process. The first step entails establishing thresholds. In order to determine your thresholds, you must first collect the relevant data. When collecting data, it is important to ensure that the data is meaningful and not erroneous. Once the appropriate data is gathered, you will use that information to identify a threshold. The QAPI process must include this step for establishing an acceptable threshold, target or goal. Although benchmarks can be set for any threshold, clinical benchmarks should be set based on the consideration of standards of care or best practice for that specific benchmark. Such information can be obtained through professional organizations, research and databases within your industry. Another good source of information is the Centers for Medicare and Medicaid Services (CMS) website.
Note: Do you want to learn more about Quality Assurance and Performance Improvement (QAPI), or have questions about how QAPI can help your LTPAC facility? Read our blog: What IS QAPI? Your Guide to the new LTPAC and Skilled Nursing Facility Standard for Quality Assurance and Performance Improvement.
What is a Performance Improvement Project in a skilled nursing or LTPAC facility?
A Performance Improvement Project (PIP) is a focused effort on a specific problem in one area of a long term post acute care (LTPAC) facility or agency, or for the entity as a whole. The process involves methodical gathering of data to bring additional clarity to facility issues or problems. The facility initiates a PIP to examine and improve care and/or services in areas that the facility has identified as areas of concern. Areas of concern will vary depending on the type of facility or agency and the distinctive scope of services provided.
Quality Assurance/Performance Improvement (QAPI) regulation was advanced as a part of the Affordable Care Act (ACA) of 2010, but the basic premise is not entirely new to long-term post-acute care (LTPAC) providers. The initiative expanded the existing Quality Assessment and Assurance (QAA) provision, thus “reinforcing the critical importance of how nursing facilities establish and maintain accountability…in order to sustain quality of care and quality of life for nursing home residents.” The Centers for Medicare and Medicaid Services has linked these initiatives to reimbursement, furthering the underlying tenet of value-based purchasing-paying for performance based upon resident-centric outcomes.
QAPI takes the QAA regulations further by incorporating root cause analysis and performance improvement guidelines. While Quality Assurance QA is the assessment of how well the facility is doing, Performance Improvement (PI) is the application of corrective actions and improvement of performance in a monitored and measured approach. The expectation is that LTPAC providers will continue to question and refine processes until optimal outcomes are met. The goal of QAPI is to improve processes in the delivery of care and ultimately improve patients’ quality of life, as well as overall quality of care.If you work in a Long Term Post-Acute Care (LTPAC) setting, you know that in our field the only constant is change. There is, however, one process that has been with us, in one form or another, for quite a long time. Until recently, Quality Assurance and Performance Improvement were two separate processes. These have since been streamlined into what we now know as the QAPI (Quality Assurance/Performance Improvement) process. Let’s start off with the CMS definition of QAPI:
If you work in a Long Term Post-Acute Care (LTPAC) setting, you know that in our field the only constant is change. There is, however, one process that has been with us, in one form or another, for quite a long time. Until recently, Quality Assurance and Performance Improvement were two separate processes. These have since been streamlined into what we now know as the QAPI (Quality Assurance/Performance Improvement) process. Let’s start off with the CMS definition of QAPI: