QAPI Basics for Skilled Nursing
Let’s start with the basics. Quality assurance has been around since the Omnibus Budget Reconciliation Act nursing home reforms. However, the Affordable Care Act of 2010 strongly emphasizes quality for all of healthcare. Then, the addition of performance improvement within skilled nursing became reality in 2016 with the final rule of Requirements of Participation. Quality Assurance Performance Improvement (QAPI) is now the foundation to manage quality. It is important to understand the foundation and expectations for the new QAPI requirement. Conversations with various providers underscore this.
So, let’s begin with an understanding of what each means:
- Quality Assurance (QA): strategies seeking to prevent, detect, and correct problems in the quality of services delivered to residents
- Performance Improvement (PI): strategies that attempt to improve quality through continuous study, modification, and improvement of services provided
Continuous improvement is key
A key function of QAPI is that it is continuous. Quality is being defined by external and internal customers. To remain competitive, you need to create a culture of quality improvement. That is, you want to continuously identify opportunities for improvement.
Teamwork makes it happen
When implementing QAPI, remember that this is a team effort. It is no longer confined to the “QAA Committee.” Staff at all levels of your facility contribute – identifying the need or opportunity, coming up with proposed processes, testing such processes, and so on. This extends beyond your internal stakeholders. Bring in perspectives from external stakeholders such as families, physicians, and consultants.
Do some light reading
You also need an understanding of developing and maintaining the QAPI process. Knowing where and how to start can be confusing. To support your initiatives, the Centers for Medicare and Medicaid Services (CMS) has many resources that not only help with the QAPI plan but also help create the culture to support your quality initiatives. These can be found at the CMS web site here. If you haven’t read through these online tools, I’d recommend doing so. For example, their self-assessment tool will help you evaluate and leverage existing processes.