The Fundamentals of QAPI for Home Health

What is QAPI?

For home health agencies, the acronym QAPI—short for Quality Assurance and Performance Improvement—has become an everyday term since CMS began requiring that agencies implement QAPI programs as a Condition of Participation in 2018.

The goal of QAPI programs is to help agencies continuously look for ways to improve organizational processes and outcomes by taking a systematic, comprehensive, and data-driven approach to maintaining and improving safety, quality, and performance. QAPI programs combine two complementary approaches to delivering better care: quality assurance and performance improvement.

In this article, we’ll provide an overview of QAPI, including why QAPI programs are so important right now, what they mean for your home health agency, and how you can solve for QAPI in a way that meets the requirements laid out by CMS and also truly benefits your agency and your patients.

What is the importance of QAPI?

Why are QAPI programs so important right now? Not only do home health agencies need to comply with the CMS mandates, but other factors—such as the shift to value-based care, referrer incentives for high-quality partners, and the narrowing of provider networks based on quality—mean that agencies today are pressed to demonstrate true high performance to payors. Designing and following a good QAPI program allows agencies to improve quality and performance overall, and results in a wide range of benefits, such as:

• A culture of continuous assessment and improvement
• Fewer mistakes or errors
• Improved patient care and outcomes
• Enhanced quality and efficiency of care
• Improved staff satisfaction
• Reduced costs
• Stronger star ratings
• Better reimbursements and more referrals

In order to implement a successful QAPI program resulting in your agency enjoying these benefits, understanding the 5 core elements of QAPI is necessary.

What are the 5 elements of QAPI?

The CMS requirements for QAPI programs are organized into five categories, often referred to as the five QAPI elements or standards.¹ Designing a QAPI program that meets these standards will help your agency fulfill the CMS requirements and improve performance. The standards are:

1. Program scope

484.65(a)(1): The program must at least be capable of showing measurable improvement in indicators for which there is evidence that improvement in those indicators will improve health outcomes, patient safety, and quality of care.

484.65(a)(2): The HHA must measure, analyze, and track quality indicators, including adverse patient events, and other aspects of performance that enable the HHA to assess processes of care, HHA services, and operations.

2. Program data

484.65(b)(1): The program must utilize quality indicator data, including measures derived from OASIS where applicable and other relevant data, in the design of its program.

484.65(b)(2): The HHA must use the data collected to:

484.65(b)(2)(i) Monitor the effectiveness and safety of services and quality of care; and 484.65(b)(2)(ii) Identify opportunities for improvement.

484.65(b)(3): The frequency and detail of the data collection must be approved by the HHA’s governing body.

3. Program activities

484.65(c)(1): The HHA’s performance improvement activities must:

484.65(c)(1)(i): Focus on high risk, high volume, or problem-prone areas;
484.65(c)(1)(ii) Consider incidence, prevalence, and severity of problems in those areas; and
484.65(c)(1)(iii) Lead to an immediate correction of any identified problem that directly or potentially threatens the health and safety of patients.

484.65(c)(2): Performance improvement activities must track adverse patient events, analyze their causes, and implement preventive actions.

484.65(c)(3): The HHA must take actions aimed at performance improvement, and, after implementing those actions, the HHA must measure its success and track performance to ensure that improvements are sustained.

4. Performance improvement projects

484.65(d)(1): The number and scope of distinct improvement projects conducted annually must reflect the scope, complexity, and past performance of the HHA’s services and operations.

484.65(d)(2): The HHA must document the quality improvement projects undertaken, the reasons for conducting these projects, and the measurable progress achieved on these projects.

5. Executive responsibilities

The HHA’s governing body is responsible for ensuring the following:

484.65(e)(1) That an ongoing program for quality improvement and patient safety is defined, implemented, and maintained;
484.65(e)(2) That the HHA-wide quality assessment and performance improvement efforts address priorities for improved quality of care and patient safety, and that all improvement actions are evaluated for effectiveness;
484.65(e)(3) That clear expectations for patient safety are established, implemented, and maintained; and
484.65(e)(4) That any findings of fraud or waste are appropriately addressed.

Note that CMS has compiled a comprehensive set of tools for helping you address each of these five standards.

How does QAPI impact my agency?

QAPI takes quality management programs to a new level by incorporating the performance aspect and by requiring your agency to continually evaluate all of your systems and processes. While creating, implementing, and managing a QAPI program involves more time and effort upfront, that work will pay off as you begin to identify the areas that your agency needs to improve and apply targeted strategies to boost outcomes.

How can MedBridge help with QAPI?

MedBridge offers effective, evidence-based resources designed to help agencies better understand QAPI and implement strategies that improve quality and performance.

The MedBridge Home Health Quality Improvement Solution helps agencies solve for QAPI by addressing key performance gaps and improving quality across multiple areas. Our industry-leading staff training and patient education help boost OASIS accuracy, improve patient satisfaction and HHCAHPS scores, reduce readmissions, and much more.

Learn more with our free QAPI resources:

Our recent guide, Your QAPI Roadmap: Getting from QA to PI, provides best-practice recommendations for tackling the performance improvement piece of QAPI.

Our free webinar, Home Health Value-Based Purchasing: Utilizing QAPI Programs to Drive Change, provides insights on how developing an effective QAPI program can help your agency achieve and maintain a quality-focused culture that drives excellent outcomes.

Our expert-led course, Home Health QAPI, provides insight and guidance on how to create or modify a QAPI program by learning about the five standards and their application within an organization.