Quick Navigation
Optimizing a QAPI program in a skilled nursing facility (SNF) can be challenging. The detailed and evolving requirements at the federal and state levels can make it difficult to ensure adherence — not to mention the staff time needed to achieve quality improvement in nursing homes. In that context, QAPI regulations that are intended to improve SNF processes may instead be viewed as burdens that hamper improvement efforts.
Of course, the COVID-19 pandemic made things even more difficult. Although the acute intensity of the pandemic has passed, the long-term care industry learned a great deal about what worked and what didn’t during that time. As a result, SNFs emerged with battle-honed quality improvement processes to better ensure the provision of optimal quality of care that helps residents enjoy a better quality of life.
That ongoing journey is largely made possible by monitoring and improving quality performance issues within a robust QAPI program — which includes staying abreast of and adhering to ever-changing QAPI regulations.
Although doing so can be overwhelming for busy SNFs, the good news is there’s help available. By implementing the right software solutions, facilities can identify quality measurement performance issues more easily, save valuable staff time, and avoid those dreaded penalties.
What is a QAPI program?
The Centers for Medicare & Medicaid Services (CMS) defines QAPI as “the coordinated application of two mutually-reinforcing aspects of a quality management system: Quality Assurance (QA) and Performance Improvement (PI).”1
According to CMS:
QA is “the specification of standards for quality of service and outcomes, and a process throughout the organization for assuring that care is maintained at acceptable levels in relation to those standards.” It is a continuous process that includes both retrospective and anticipatory efforts to identify how well an organization is performing and if there are issues that need to be addressed.
PI is “the continuous study and improvement of processes with the intent to better services or outcomes, and prevent or decrease the likelihood of problems, by identifying areas of opportunity and testing new approaches to fix underlying causes of persistent/systemic problems or barriers to improvement.” In SNFs, the goal of PI is to improve processes related to both healthcare delivery and quality of life for residents.
With the enactment of the Affordable Care Act in 2010, the two were combined, creating the QAPI acronym. A provision in the new legislation expanded required QAPI activities to better ensure the continual identification and correction of quality deficiencies — as well as sustained performance improvement.
Noting that QAPI “takes a systematic, comprehensive, and data-driven approach to maintaining and improving safety and quality in nursing homes,” CMS says a QAPI program also includes “involving all nursing home caregivers in practical and creative problem solving.”
Common questions on running an effective QAPI program
If you have questions about quality measurement in your facility’s QAPI program, you’re not alone. Here are some of the most common questions along these lines — as well as the most effective ways to address them.
Am I meeting my SNF QRP requirements?
The Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) creates SNF quality reporting requirements as mandated by the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). According to CMS, the IMPACT Act “intends for standardized post-acute care data to improve Medicare beneficiary outcomes through shared-decision making, care coordination, and enhanced discharge planning.”2
CMS adds new measures, modifies existing measures, and removes measures from the QRP through its annual public rule-making cycles.3 Through this process, the quality measures SNFs must report are updated each year by October 1.2
Currently, there are 16 quality measures in the SNF QRP.3 Data for these measures are collected and submitted through three methods:
Minimum Data Set (MDS) 3.0
Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN)
Medicare Fee-For-Service Claims
Noting that failure to submit the quality data required can result in a 2% reduction in the facility’s Annual Payment Update, CMS says that to achieve compliance, SNFs must “meet or exceed” two thresholds of data completeness:
“One threshold, set at 80%, for completion of quality measures data collected using the MDS and submitted through the CMS Quality Improvement and Evaluation System (QIES) Assessment Submission and Processing (ASAP) system
A second threshold, set at 100%, for quality measures data collected and submitted using the CDC NHSN”
In an evolving regulatory environment with such detailed submission requirements, it’s not surprising that SNFs are concerned about whether their QAPI program is effectively addressing QRP regulations.
That’s where an effective software solution can be invaluable. With the right software, SNFs can streamline and enhance care quality management efforts via SaaS-based documentation and analytics.
By implementing technology that supports SNF QRP requirements, facilities can keep up with government regulations and make the most of easy-to-read dashboards that provide alerts about quality issues that need attention.
How do I get my staff to use the software solutions we purchase for them?
It’s one thing to have the right technology in place. But it can be another thing to get staff to use it to its full potential.
When any type of software solution is implemented, key staff should be involved. This helps staff become engaged and excited about the powerful solutions at their fingertips.
Getting there means providing the training needed to help them make the most of the technology available. At Inovalon, our nurse educators train facility nurses, teaching them how to both read the data and act on it.
How can I achieve the same results with fewer staff?
It seems nearly every SNF is struggling with staffing issues —which can really create a challenge when it comes to meeting the objectives of a QAPI program.
Fortunately, Inovalon offers software solutions like MDS Intelligence, Risk Management, and Infection Surveillance, which can help SNFs identify and manage problem areas. This helps reduce time-wasting manual processes used to identify areas in need of QAPI initiatives.
Plus, our workforce management solutions can help identify nurse burnout which contributes to higher rates of turnover and can have a negative impact on the quality of care.
Our Workforce Intelligence software solution even offers powerful data analytics insights on staff well-being which can help drive better patient care. The intuitive dashboards provide on-demand access to staff sentiment metrics so potential issues can be mitigated before they occur.
Best practices for SNF quality measurement
In addition to those already mentioned, SNFs can enhance QAPI program efforts by embracing the following best practices.
View quality improvement through a “continuous” lens
An effective QAPI program is about much more than creating a quality improvement project, submitting the required data, and then crossing it off the list. Instead, CMS expects QAPI to govern a facility’s quality initiatives — which is why QAPI program plans should not be approached with a “one and done” mentality. Data should be viewed as a living and evolving entity that informs the continual monitoring of quality initiatives so new issues can be identified and changes made as needed.
Create and maintain accountability
While having access to valuable quality data is important for SNF leaders, that’s not enough to ensure continuous quality improvement and the optimization of patient care. Instead, leaders need to also ensure that the data informs a plan of action and that the staff responsible for implementing it follow through. Accountability is key to success across the board — which includes a SNF’s QAPI program, risk management, and infection prevention and control.
Best practices from the Institute for Healthcare Improvement
Based on recent research, the Institute for Healthcare Improvement also recommends that SNFs incorporate the following key points to support effective quality improvement efforts:
Capitalize on the strengths of nursing home staff — who build strong relationships with residents and want to help improve their quality of care and quality of life
Relentlessly focus on practicality — to help engage staff who are juggling multiple responsibilities in “highly constrained circumstances”
Recognize and respect the concerns and motivations of nursing home staff — since understanding motivations for action can help inform efforts for change
Develop and support a robust and resilient culture of safety and inquiry — which withstands the temptation to put quality improvement efforts on the back burner when other matters seem more pressing
Build trusting and supportive relationships with engaged leaders — who are committed to ensuring that staff have the support they need and will in turn reap the rewards of doing so
Getting the right support for your QAPI program
Although it can be daunting to meet the myriad requirements of a SNF QAPI program, some of the stress involved can be reduced by implementing the right technology to support your efforts.
Inovalon empowers SNFs by offering a suite of care quality management software solutions to help them make better-informed care decisions, improve outcomes, and maximize reimbursements.
With built-in analytics, staff can assess facility and organization-wide performance on risk management, infection control, and quality metrics and leverage this data to improve internal processes, care quality, and documentation accuracy.
Contact us to learn more about our QAPI program solutions.
Sources:
1 “QAPI Description and Background.” Centers for Medicare & Medicaid Services. Accessed May 17, 2023. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/qapidefinition
2 “Skilled Nursing Facility (SNF) Quality Reporting Program (QRP).” Centers for Medicare & Medicaid Services. Accessed May 17, 2023. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-Program/SNF-Quality-Reporting-Program-Overview
3 “Skilled Nursing Facility (SNF) Quality Reporting Program (QRP…)” Centers for Medicare & Medicaid Services. Accessed May 17, 2023. https://www.cms.gov/files/document/fy2023-snf-qrp-faqs.pdf
Inovalon and design®, Inovalon® are trademarks of Inovalon, Inc.
