Implementing a QAPI Program in Nursing Homes

Anaheim—The Patient Protection and Affordable Care Act requires nursing homes to have an acceptable Quality Assurance and Performance Improvement (QAPI) plan within a year of a final QAPI regulation, meaning each facility will have 1 year from the date of regulation to be in compliance. The Centers for Medicare & Medicaid Services (CMS), which is responsible for the implementation of QAPI and ultimately responsible for drafting the QAPI regulations, has not announced a date for publication of the final rule.

During a session at the NADONA conference, Cindy Mason, LCSW, NHA, LHRM, vice president, provider services, Providigm, discussed how to use Quality Indicator Survey (QIS) methodology to implement QAPI.

QAPI is a data-driven, proactive approach to improving quality of life, care, and services in nursing homes. Ms. Mason described QAPI as 2 functions that go hand-in-hand: quality assurance (QA) and performance improvement (PI).

QA is the process of meeting quality standards and assuring that care reaches an acceptable level. Nursing homes typically set QA thresholds to comply with regulations. They may also create standards that go beyond regulations. QA involves measuring and tracking indicators to find out where the facility is performing well and where there are opportunities for improvement.

PI in nursing homes aims to improve processes involved in healthcare delivery and resident quality of life, which is accomplished by identifying areas of opportunity and testing new approaches to fix underlying causes of persistent/systemic problems. PI is the reaction and correction to an opportunity to improve, explained Ms. Mason.

“QIS provides the framework for a QAPI system,” said Ms. Mason. Continuous survey readiness, continuous QA, and PI can be done with QIS, which uses a 2-stage approach. Stage 1 is for preliminary investigations and stage 2 is for in-depth investigations.

CMS developed a general framework for implementing a QAPI program in nursing homes based on 5 key elements of effective quality management. The QIS methodology can be applied to help nursing homes prove that they meet these elements, explained Ms. Mason, who provided an overview of the 5 elements and examples of how the methodology can be applied:

1. Design and Scope: All staff must know they contribute as individuals to “the big picture” of meeting the resident’s goals for quality of life and quality of care

2. Governance and Leadership: Residents should have control over their lives, influence decisions that affect them, and know that their opinions matter

3. Feedback, Data Systems, and Monitoring: A strong approach to quality management, such as QAPI, uses performance indicators to monitor a range of care processes and outcomes. Then it reviews against benchmarks and targets the facility has established for performance

4. Performance Improvement Projects (PIPS): Conducting PIPS allows the nursing home to examine performance and make improvements in any area identified as needing attention or that is found to be high-priority or high-risk based on the needs of residents

5. Systematic Analysis and Attention: To be effective, interventions or corrective actions should target elimination of root causes, offer long-term solutions to the problem, and be achievable, objective, and measurable

Ms. Mason concluded that improved care across the board will likely occur by establishing this framework as a foundation along with the collaboration of staff members and continuing conversations with residents.—Eileen Koutnik-Fotopoulos