Helpful suggestions for an effective QAPI program
By 21st Century Health Care Consultants
21st Century Healthcare Consultants knows that all providers want to understand what they can do better, how to prevent billing denials, and take a more proactive approach to documentation. Medicare requires agencies to take a quality-driven approach in all aspects of healthcare services provided to a patient. Yes, doing all that translates into dollars.
To work with CMS, all agencies must clean house and align themselves to be quality driven. It is no different than anything else we do in our ordinary lives. We already track outcomes— a manager submits a performance evaluation of her staff, showing opportunities for improvement and when our car is serviced the mechanic test drives it to ensure that the problem was fixed. So why are we complaining about doing the right thing to get paid? Because it is called “work”!
Changes are inevitable and providers must implement changes timely, correctly, and monitor for outcomes.
Having the right people driving the bus in your agency is key. At 21st Century Health Care Consultants, our experts address corporate compliance through education. We seek to help you identify roles and responsibilities within your company and how best to have oversight in key areas.
Are you identifying the correct indicators to track? Do you have the right programs in place to address indicators? At 21st Century Health Care Consultants, we can help you develop tools to proactively track, review, and analyze these indicators. This is critical for best practice and Surveyors will applaud you.
Collecting data is not just about numbers, you must be able to interpret the information from your reports. What do you do with the data that you are collecting? At 21st Century Health Care Consultants we can coach you in how to turn data-driven results into opportunities for improvement.
Have you identified your “high-volume, problem-prone” areas of concern? At 21st Century Health Care Consultants works with you on data you have collected, then uses a systematic process to identify the root causes of problems or events, and offers an approach for responding to them.
Tracking data from indicators is an ongoing process. Therefore, 21st Century Healthcare Consultants assists in quarterly reviews of an agency’s activities, using an approach to the continuous study and improvement of the processes in place to provide healthcare services that meet the needs of patients.
In summary, keeping meticulous records requires providers to understand the “whys” of what they are doing. Medical records should tell the story, which must consist of various, vital parts to reach a successful conclusion. Freytag’s pyramid tells us that the story must include the following parts:
Exposition tells us what brings the client to need services, including the medical history and the face to face interaction. The climax is the diagnosis where all the signs and symptomatology are identified, but the record is incomplete or missing sections. Composing the story, we all know we need a complete record to understand the end. Without all the parts we cannot finish the story nor can CMS. Having correct information allows everyone who reads the records, including CMS, to understand why the client requires ongoing care. Finally, you must take critical data from the records to measure what you do.