For some nursing homes, quality assurance and performance improvement (QAPI) meetings serve merely as a checkbox for requirements, but they haven’t driven changes to improve care quality outcomes.

On the flip side, however, other nursing homes are effectively using QAPI meetings to push for success in quality of care. Executives at these facilities emphasize that their secret lies in implementing actionable QAPI practices through consistent meetings with the right staff mix, and undertaking less burdensome performance improvement projects.

Moreover, as these nursing home operators figure out ways to make QAPI more meaningful, they are drilling down on specific data points related to high risk areas or those more directly tied to surveys, instead of having a flood of data on a variety of different topics. As a result, QAPI meetings for some have become a proven tool for launching revenue drivers and helping with quality outcomes.

“QAPI at its core, is about doing things better today than we did yesterday, right? We’re looking for problems and we’re fixing them,” said Leslie Zimmerman-Black, regional director of clinical services, management division for Mission Health Communities. “I see a couple of things happening … either [nursing homes] have no QAPI at all, while others might be doing some things that look like QAPI, but it’s not strategic. They can’t articulate what they’re doing, and it’s really not meaningful to them.”

Zimmerman-Black spoke about QAPI at Skilled Nursing News’ RETHINK conference in Chicago, along with Donna Farr, president of Touchpoints Therapy and vice president of quality assurance and performance improvement at Connecticut-based iCare Health Network and Katie Hughes, regional nurse consultant for Allure Healthcare Services.

While the QAPI program was first announced in the 1980s, the Affordable Care Act required that all skilled nursing facilities develop QAPI programs as part of requirements of participation, to “develop, implement, and maintain an effective comprehensive, data-driven QAPI program that focuses on systems of care, outcomes of care, and quality of life,” according to the Centers for Medicare & Medicaid Services (CMS).

Nursing homes are doing themselves a disservice when they conduct surveys, complete reports, and gather all sorts of data but end up not doing anything with it, Zimmerman-Black said. In these cases, it’s a burden, and not meaningful, and could be used to create impactful QAP meetings.

Farr echoed Zimmerman-Black’s thoughts on QAPI meetings, saying operators focus too much on the presentation of information they’re gathering as part of the program, while others are under thinking because they are proceeding with QAPI meetings as a box to check off, not something out which they can derive value.

Less action with QAPI stems from a lack of understanding around the program, and a lack of time for staff to actually implement performance improvement initiatives.

“We all are short on time in our roles … we’re asking staff that are already spread way too thin to get together and collaborate and come up with solutions and brainstorm,” said Farr.

Making the most of QAPI

Hughes suggested QAPI could be structured differently to better serve the industry and its staff today. For one, nursing homes can drill down on pressure points related to high risk areas, or anything that will be survey related, in order to make the data more valuable.

Ultimately, meaningful QAPI outcomes are driven by leadership, collaboration and innovative approaches, panelists said.

“When you’re in a crunch, you may be able to put the numbers together but the data means nothing,” Hughes said. “Allure has developed a different way to do QAPI on a weekly basis. We pull our interdisciplinary team in for one hour every week: dietician, social services, MDS, [Director of Nursing], and external vendors, in some instances … we sit down and we go through a list of topics on a weekly basis.”

Similarly, Farr said iCare does weekly meetings to address immediate needs including falls prevention, weight loss and grievances. The facilities also hold monthly meetings to address performance improvement plans, looking for feedback.

At iCare, the regional MDS nurse is included in some QAPI monthly meetings to drill down on quality measures, Farr said, while others focus on financial planning.

Lastly, quarterly meetings with high-level personnel and the legal team, review each building’s QAPIs and determine if they’ve made improvement, or if certain programs need to be discontinued, Farr noted.

Mission Health does their QAPI meetings every month, Zimmerman-Black said, while quality assurance activities occur quarterly or annually. In terms of performance improvement projects, the leadership staff looks at surveys, their publicly reported data and benchmarks, and ask themselves if they’re meeting the risk events and grievances reported.

From there, each building figures out a couple of projects to work on, maybe it’s a high risk event or something that affects a lot of people. This discussion could mean a new service line like a dialysis den, or working with a new vendor partner, implementing new software.

“We figure out what their goal is, what are the things that they want to work on. I encourage them not to take on too much at once,” said Zimmerman-Black.

Utilizing QAPI

When they were initially required, QAPI meetings were very high level, usually with the top five executives involved, Hughes said. Now, with QAPI being used to drill down to fix specific issues, it can be seen as a tool for doing an acquisition successfully, or launching a new business line.

Also now, there’s been a bit of a paradigm shift in how these meetings and improvement projects can help with quality outcomes and revenue.

“If you don’t deep dive into the other layers, you’re never going to fix anything. It’s like beating a dead horse,” said Hughes. “As [QAPI] evolves, and people are starting to do it differently, we’re realizing that we can utilize it to fix so much more.”

Eventually, drilling down using QAPI will get operators to the root cause of an issue instead of just treating the symptoms.

“I’ve seen this time and again where [nursing homes] complete their QAPI, and they probably have shown some improvement, but they haven’t really taken a deep dive into all the factors,” Farr said. “Let’s face it, everything we do on a daily basis is complex with our patients. There’s a lot of factors that go into their care, and I think it’s important to keep going back, and even though you’ve seen success, ask, ‘Did we find every problem that could have caused that?’”