If your home health or hospice care agency struggles with ensuring compliance and patient safety, you’re not alone. Tackling the administrative tasks of a home health or hospice care agency is daunting enough, before all the vague government mandates and regulations. Especially when all you want to do as an owner or administrator is ensure your patients are getting top tier care from your agency.
At The Home Health Consultant (THC), we’ve helped over 1,000 home health and hospice care agencies implement key strategies to thrive in this demanding industry, including a vital process called QAPI. In this article, you’ll learn what QAPI is and how to successfully implement it in your organization.
What is QAPI?
While you may have heard of the five pillars of QAPI, outlined by The Center for Medicare and Medicaid Services (CMS), you’re probably still left wondering what QAPI actually is and how it works. To keep your agency in top shape and avoid dangerous and costly compliance issues, Quality Assurance Performance Improvement (QAPI) is crucial.
QAPI is a structured process that encourages agencies to zoom out and look at all processes, emphasizing what can affect patient health and safety the most—then, improving these processes one at a time. Each QAPI is centered around resolving one concern, or improving one process. But what does it actually look like?
There are four general steps in a QAPI:
- IDENTIFY: Find the most pressing problems. Always prioritize concerns that are the most dangerous to patients and staff
- PLAN: Create or improve a plan or procedure directly related to the concern. Set a clear goal for the amount of improvement you want to see
- EDUCATE: Teach patients and staff about the updated plan or procedure
- CHECK PROGRESS: Always be sure to monitor progress in a QAPI through your own data and patient/staff feedback
As a member of our Administrative Compliance Program, the first QAPI we usually recommend is centered around patient and staff feedback. You may be asking yourself, well why is that so important?
If your patients and staff don’t feel they can share their issues with you, how will you know they’re having issues at all? Patient feedback is typically the first QAPI, so you can work with patient feedback and your own data to make a well-educated decision on which processes need a QAPI next.
After identifying the concern you want to address in your QAPI, the next step is to create or improve a plan or procedure. For example, if your agency has been experiencing a high level of falls due to bed transfers, that process must be improved and then taught to clinicians and patients. Once you’ve educated your staff and patients on the correct way to conduct a bed transfer safely, you often see immediate improvement.
When starting a QAPI it’s also incredibly important to set goals. These goals are determined by referencing the national standard, such as the national rate of falls, against your own data. CMS provides a great resource on how to set SMART goals. SMART is an acronym for Specific, Measurable, Achievable, Relevant, and Time-bound goals. With a clear goal in mind, it becomes easier to know what to spend more time on, or move away from.
QAPI is an incredibly powerful tool because it helps you find compliance issues within your agency at their root cause. Only by understanding the cause of a problem can you effectively solve it.
Why is QAPI So Important & What Are the Benefits?
QAPI is required for home health and hospice care agencies as a condition of participation (COP). A COP, put simply, is a very important rule that home health and hospice care agencies cannot break if they want to continue to work with Medicare. So naturally, understanding QAPI and its benefits is paramount to any agency that wants to see success.
Imagine this very real scenario. You have a diabetic patient on insulin. Your clinician is administering the insulin, but the patient’s health is steadily declining. The California Department of Public Health (CDPH) is called to investigate a complaint regarding this patient’s health. In the investigation, they find that your clinician was giving the incorrect dose of insulin, resulting in the patient’s health declining. Because of this, your agency receives an immediate jeopardy citation, leading to provider termination.
As an owner or administrator, a million questions would start running through your head. “How did this happen? How long has this been going on? Why did no one tell me about it? What happens to my business now?”
QAPI ensures your ability to prevent this exact scenario before it happens, simply by being aware of any issues in your agency. If you're constantly looking for ways to improve your agency versus just being reactive in the day-to-day, you will have a different outcome.
First, your business’s longevity will improve. Without a solid QAPI system in place, your agency could face unexpected compliance issues. For example, if a patient files a complaint with the health department, surveyors may uncover problems your staff wasn’t even aware of. These issues can escalate quickly, potentially leading to fines or even a shutdown. QAPI helps you catch and resolve these problems early before they become larger threats to your business.
Secondly, patients love feeling seen and heard when it comes to their care. QAPI doesn’t only improve your compliance, it also improves your relationship with your patients. Overall, your patients will be happier because they’ll receive better care, which means better outcomes. Happier patients lead to more referral sources. In addition, satisfied patients are more likely to bring any concerns directly to your staff, giving you the chance to fix issues internally—before they escalate to external complaints.
3 Proven Tips for Successfully Implementing QAPI
So now you may be thinking, “Okay I see the importance of QAPI, but how do I actually implement it successfully at my agency?” Here are a few tips and tricks for how to get your Home Health or Hospice Care Agency QAPI ready.
- JUST DO IT: When implementing QAPI, just do it. In terms of the results of a survey, just doing QAPI, even if you're not doing it right, usually gives you enough points to pass.
- KNOW WHEN TO MOVE ON: It’s important not to get hung up on a singular issue when there are other important processes to address. If you’re close enough to a goal, it’s better to move on to the next issue than to keep trying to bridge the gap of a percentage or two.
For example, if an agency is focused on oral medication management during the first quarter and is 90% of the way to achieving that goal, it’s better to shift focus to a secondary high-priority issue, like falls, which may only be at 50%. This prevents creating a blind spot in other critical areas.
- KEEP YOUR OWN DATA: Agencies should always keep their own data, so they aren’t left waiting for OBQI (Outcome-Based Quality Improvement) results to come in, often too late. Surveyors want to see a QAPI reflective of OBQI data and other similar formalized data sources.
But, keep in mind that the reporting of those data sources lags by a couple of months. Keep your own data because you're always going to be months behind with OBQI reporting. By the time you get the results from quarter one, you're on quarter three, leaving the effects of your efforts unknown.
What if I Need Help Implementing QAPI?
Incorporating a seasoned, well-educated consultant can make all the difference in achieving your patient care goals. At The Home Health Consultant (THC), QAPI is just one aspect of the broader support we offer to home health and hospice care agencies through our Administrative Compliance program. Our process begins with a comprehensive assessment of an agency's OBQI data, where we analyze patterns and trends to pinpoint areas needing improvement. We then collaborate with the agency’s liaison—often the owner or administrator—to review the data and determine key topics for focus during the first quarter.
Once the critical issues are identified, THC guides the agency step-by-step through a tailored action plan. With experience working with over 1,000 businesses, we have a wealth of templates and best practices ready to deploy, based on proven success in other companies.
However, each agency's challenges are addressed with a custom approach. By conducting a symptomatic assessment, we identify the problem and apply treatments that have already been fine-tuned through years of practice, making the entire process both time-efficient and effective.
QAPI isn’t just about meeting regulatory requirements; it’s about improving patient outcomes, preventing costly compliance issues, and ensuring long-term business success. THC is here to help you navigate these challenges and put effective QAPI systems in place. Schedule your consultation to get started on the path to a healthier, more compliant agency today.
*This article was written in consultation with Mariam Treystman.
This article was written in consultation with Mariam Treystman
This article was written in consultation with Mariam Treystman
This article was written in consultation with Mariam Treystman
This article was written in consultation with Mariam Treystman
This article was written in consultation with Mariam Treystman
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