Striving for quality peak performance should be a key goal for every home health and hospice agency. CMS has been working on new payment models designed to tie payments to quality and rewarding agencies for efficiency and effectiveness. Additionally, as the aging population becomes more web-savvy, they’re using the internet to research agencies before making a decision.
In fact, since 2003, quality performance data has been available on Home Health Compare. This data includes outcome measures that indicate how well HHAs assist patients in regaining or maintaining their ability to function. It also includes process measures that evaluate the rate in which HHAs use specific, evidence-based care processes. In 2015, CMS added star ratings to summarize performance to further support guide and support decisions.
In 2017, CMS launched Hospice Compare. This allows patients, family members, and health care providers to gain insight into the quality of care each hospice provides. Hospice Compare includes seven NQF-endorsed Hospice Item Set (HIS) quality measures.
What is Quality Care?
CMS has adopted the mission of The Institute of Medicine (IOM) which defines quality as having the following characteristics:
- Effectiveness: Providing care processes and achieving outcomes as supported by scientific evidence.
- Efficiency: Avoiding waste, including waste of equipment, supplies, ideas, and energy.
- Equity: Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.
- Patient Centeredness: Meeting patients’ needs and preferences and providing education and support.
- Safety: Avoiding harm to patients from the care that is intended to help them.
- Timeliness: Reducing waits and sometimes harmful delays for both those who receive and those who give care.
It is up to home health and hospice agencies to ensure that they provide quality care, while managing costs.
Quality Assurance/Assessment & Performance Improvement
Effective Quality Assurance/Assessment and Performance Improvement (QAPI) is critical to improving care while reducing costs. When properly launched and sustained, a good QAPI program enables achievement of quality peak performance by:
- Solving quality problems and preventing their re-occurrence
- Identifying opportunities to achieve new goals
- Providing better care for your patients
Let’s break down the two pieces of QAPI – Quality Assurance/Assessment and Performance Improvement.
QAPI is a comprehensive approach to assuring high quality care, combining two separate, but complementary approaches to quality management — Quality Assurance/Assessment and Performance Improvement. Essentially, QA + PI = QAPI.
According to CMS, Quality Assurance/Assessment (QA) “is a process of meeting quality standards and assuring that care reaches an acceptable level.” QA is a reactive, retrospective effort that looks at where and why your agency is at risk and where you may have failed to meet standards.
While the QA process uses quality-based information to assure that agencies meet quality standards, Performance Improvement, or PI, is intended to make good quality even better. CMS says PI is a “proactive continuous study of processes with the intent to prevent or decrease the likelihood of problems by identifying areas of opportunity and testing new approaches to fix underlying causes of persistent/systemic problems.”
When you combine the two together, you have a complete picture of your quality operations – knowing where you are meeting standards, where you need to improve, and how you need to get there.
Achieving Quality Peak Performance
An important component of QAPI is using data to not only identify quality problems, but to use that data to develop plans for improvement. However, how should you track information to make decisions for performance improvement? Here’s what peak performers do:
- Use the tools, reports, and alerts found in home health software or hospice software. Many EHR systems, like HEALTHCAREfirst’s, offer reporting that can be used to help track clinical performance. You should consider tracking high-risk, high-volume, or problem prone areas of service, considering the prevalence and severity of problems.
- Consider adding quality analytics to your technology mix. While EHR systems are great at capturing a significant amount of data, peak performers know that they need robust data analytics tools to really dive into key drivers. These tools, such as our home health analytics and hospice analytics, can help you go beyond simple data collection and reporting. They can provide useful insights that allow for strategic management of clinical processes and data-driven performance improvement.
- Thoroughly review your Hospice CAHPS and HHCAHPS data. Simply collecting and reporting patient and caregiver data cannot truly spark performance improvement efforts. To achieve quality peak performance, you really need to dig into your CAHPS data, developing strategies and action items. This allows you to focus on areas that need improvement so you can build solid, patient-centered clinical processes.
In closing, CMS has made it very clear that quality should be a top priority for home health and hospice agencies. As a result, you must ensure that your agency operates at quality peak performance to thrive. HEALTHCAREfirst offers a number of solutions to help your agency reach the highest level of quality so you can ensure proper reimbursement and gain more referrals.
The HEALTHCAREfirst Difference
HEALTHCAREfirst has the solutions home health and hospice agencies need to achieve quality peak performance.