3 Tips for Clearing Quality Improvement Hurdles in Home Health

Home health providers cite a variety of challenges to Quality Assurance and Performance Improvement (QAPI) program implementation, but a few simple tips could help keep them on the right track.

In fact, QAPI is the “perfect vehicle to create quality improvement” in home care—at least that’s what Mary Rodger said at the National Aging Services Management Conference in Chicago last Thursday. Rodger is senior risk management analyst and consultant at the ECRI Institute. The conference, hosted by Caring Communities and the Peace Church Risk Retention Group, in conjunction with ECRI Institute, convened nonprofit providers to explore best practices in identifying and managing risks, fostering a culture of safety and becoming a high-reliability organization, according to Caring Communities’ website.

Last October, the Centers for Medicare & Medicaid Services proposed an update to the home health agency (HHA) Conditions of Participation. The proposal involved each HHA defining, implementing and maintaining an ongoing, data-driven, HHA-wide QAPI program. The proposal also states that every HHA would have to maintain documentary evidence of its QAPI program to vouch for its operation to CMS.


In a poll question to conference attendees, Rodger asked nonprofit home care providers to name their biggest challenges to implementing QAPI. “Time” was reported as a common challenge, while challenges such as “competing priorities,” “staff education” and “teamwork” were also mentioned.

Rodger also noted that the independent nature of home care work and a staff unaware of QAPI may present challenges to QAPI implementation.

For nonprofit home health providers who have yet to implement QAPI programs, Rodger offered some tips.


1. Start small.

Rodger specifically advised against rolling out big programs, instead suggesting to “start small.” She mentioned program implementation may involve unintended consequences, and recommended sharing data and successes with clients, families and staff.

2. Use PIPs sparingly.

Rodger also said all identified problems require attention, but not all need a performance improvement project (PIP). CMS defines a performance improvement project as a concentrated effort on a particular problem in one area of the company or company wide; it involves collecting information systematically to clarify problems or issues, and intervening for improvements.

3. Use complaints as a launching pad.

Additionally, though family and resident complaints are often a valuable way of identifying more general problems, they are underused, Rodger said — and these complaints can serve as a launching pad to solve important problems.

The ECRI Institute is a nonprofit organization with over 5,000 members and clients dedicated to bringing the discipline of applied scientific research to discover which medical procedures, drugs, devices and processes are best to improve patient care.

ECRI’s members and clients include health systems, hospitals, private and public payers, U.S. federal and state government agencies, associations, ministries of health, and accrediting agencies worldwide, according to the company’s website.

Written by Mary Kate Nelson

Companies featured in this article: