The Benefits Of Strong QAPI Programs In Home Health Care

Quality Assurance and Performance Improvement (QAPI) programs have been ubiquitous in the home health space for the past few years, but in light of the nationwide expansion of the Home Health Value-Based Purchasing (HHVBP), the process may begin to hold more weight than ever.

Broadly, QAPI is a catch-all term for any kind of auditing or quality metrics at a home health agency.

“QA would be the review of documentation, orders to clients. And then performance improvement would be the plan after you get the results of that review,” Sherry Teague, co-owner and co-founder of consulting firm Kornetti & Krafft Health Care Solutions, told Home Health Care News.

Though the concept of QAPI has been around for a while, it became standardized in home health when updates were made to the conditions of participation in 2018.

The goal of QAPI is to ensure that agencies are continuously looking for ways to improve the ways that they operate.

“This can mean improvements in organizational process, or improvements in safety, quality performance — it’s really looking at where the agency is potentially deficient, and where are opportunities to improve,” Joseph Brence, head of clinical strategy at MedBridge, told HHCN.

The Seattle-based MedBridge develops evidence-based solutions for health care organizations.

With HHVBP, home health stakeholders are really seeing where QAPI can be tied to better outcomes, which is then tied to better reimbursement, according to Brence.

“For example, let’s say that in your QA process you identified that you have an inaccuracy in how you’re answering certain OASIS items,” he said. “Then you implement a performance improvement plan which entails education to your staff to improve how you answer those questions. If you see that boost and that improvement in OASIS accuracy, that could be tied to better payment with value-based purchasing.”

Brence noted that his example could also be applied to ED utilization and hospitalization.

“If you deploy a QAPI program and it’s impactful, it can impact your downstream payment with [HHVBP], so essentially getting paid more for boosting those outcomes,” he said.

While a strong QAPI may lead to a potential payment boost, the financial gain shouldn’t be the main reason behind these programs, Teague said.

“QAPI is about being accurate and staying within the rules, or the guardrails, of CMS,” she said. “You can do, at the same time, a utilization review and a revenue review on closed charts to make better decisions going forward. It’s more of an educational process, and it typically occurs after that chart is closed, or after that chart is built. Ideally, it would occur as the care is taking place.”

Interim aims for quality

Charles McDonough, CEO of Interim HealthCare of the Upstate, is no stranger to QAPI. The company is an independently owned and operated franchise of Interim HealthCare located in South Carolina.

“Anytime that we put together a good QAPI, we look at areas where we are deficient, or not stepping up to muster, if you will, top performance within certain benchmark areas,” he told HHCN.

McDonough noted that these areas can include things like patient satisfaction surveys, hospitalizations, falls, wound documentation and more.

The overall goal is making sure Interim has a program that keeps the organization focused on patient enrichment activities.

“It’s about making sure we continue to move the needle related to our quality of care efforts,” McDonough said. “That has always been the basis. We want to make sure we continue to better ourselves. If there are areas that we feel that we are deficient in, or we want to continue to grow, we focus on those areas from a clinical quality of care standpoint.”

Typically, the organization runs QAPI programs on quarterly tracks. At Interim, this year’s program is related to quality education improvement initiatives.

“We will take specific measures and we will track them quarter-over-quarter and really dig in and engage and make sure the clinicians, all the way up to the clinical administrators, are sharing and aligned to the same goals,” McDonough said.

As result, Interim has seen improvement around its wound care documentation and hospitalizations due to decline in surgical wounds.

In order to have a strong program, Interim utilizes a mix of external and internal resources. The company has a director of quality and performance improvement on staff.

“She’s actually the quarterback of the whole process,” McDonough said. “She’s the one that puts all the pieces together. She identifies the trends and works with operational management and the teams to understand where we’re trying to get.”

The company also outsources some of the record reviews to ensure they are “keeping themselves honest” from a record-tracking perspective.

“We understand there are people out there that can help us achieve our goals,” McDonough said. “When we can leverage our internal resources we look there first, but if there are partners that we can ally with to help us achieve our goals, then we do that as well. It’s really a hybrid approach.”

Looking ahead, he believes that any provider that wasn’t already focused on QAPI will soon be.

“The industry has been preparing for [HHVBP] for the past decade, a lot of people have been focusing on hospitalization rates, getting higher reimbursement, etcetera,” he said. “The federal government has been piloting [HHVBP] over the past five years. Now it’s here, so organizations that don’t have a QAPI program or initiative are going to likely suffer payment reductions.”