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Patti Cullen's Blog

Just don’t have time for all of that quality stuff?

by Patti on Wednesday, March 28, 2012 12:32 PM

When I spoke to a group of members recently, there were more sighs than whoops when discussing another quality initiative. This caused me to reflect on all of the quality irons in the fire and why this is the new focus for all members — whether nursing facilities, senior housing, home care or business partners. We have entered a new era of customer expectation — whether the customer is the baby boomer children assisting parents with selection of a service, or whether the customer is the government, who is an ever-increasing payer for many of our services.

And, in the effort to be responsive to our customers, there is a whirlwind of activity around quality measures, quality improvement and quality mandates. I want to do a quick “speed read” of some of these “formal” initiatives first before I editorialize on the importance of making time to infuse a quality culture at all levels of staffing:

  1. Centers for Medicare and Medicaid Services (CMS) — the federal agency that creates payment and regulatory oversight mechanisms has been developing and publishing quality measures for both home care and nursing facilities. The federal health care act included provisions giving direction to CMS to continue with programs/mandates to improve quality.

  2. QAPI or Quality Assurance & Performance Improvement Initiative: Minnesota is one of the demonstration states for this initiative — the Affordable Care Act provides the opportunity for CMS to mobilize some of the best practices in nursing home QAPI and to identify technical assistance needs in advance of a new QAPI regulation. So, the current demonstration is setting the groundwork for new regulations.

  3. The Dayton administration is very interested in advancing a “pay for performance” type of approach for all of the programs it supports — and has stated that future increases will need to be tied to some sort of performance measure. We will be meeting with Department of Human Services staff in the near future to begin the discussions about what this would mean for nursing facilities, as a starting point.

  4. American Health Care Association/National Center for Assisted Living (AHCA/NCAL) is promoting a quality initiative with four core areas of interest — tied closely to the areas of interest identified by CMS: reducing hospital readmissions, improving staff stability, increasing resident satisfaction, and reducing the off-label use of antipsychotics. More information about this quality initiative can be found on the ACHA/NCAL website here

  5. Health system expectations: as hospitals are facing financial penalties for their readmission rates, health systems are responding by meeting with community partners to determine where they should focus their post-discharge referrals. Nursing facilities and assisted living establishments that can demonstrate through data and practice that they are focusing on reducing readmissions and creating positive care transition experiences are more likely to be preferred referral sites.

  6. Health care reform activities: Minnesota always seems to lead the pack, and quality measures are no exception … tied into federal demonstration proposals from the state and the activities of the state’s health care reform task force are quality measures, some as defined by Minnesota Community Measurement and others self-defined. The road map is expected by November on the state health care reform initiatives.

In response to some of these initiatives, the Association has been focusing this year on a few new partnerships — partnerships that will provide benefits for our members as they must turn their focus from regulatory compliance to quality improvement and performance excellence. We can’t ignore the changing tides and the changing expectations of all sorts of stakeholders — from regulators to referral sources to the customers we serve. Here are a few ways we are gearing up for the “wave” of quality improvement/performance excellence:

  • Late last year the Association began a partnership with the Minnesota Council for Quality, an organization that advances improvement and performance excellence within organizations, individuals, and communities. The partnership will allow our members to attend some of the Council's programs to learn more about performance excellence and quality leadership.

  • Our Service Corporation has been reviewing the many products and services that have been developed under the banner of preventing rehospitalizations and brought forward these issues to our Board of Directors last week. We will soon be sending out an assessment survey to members to determine what our next steps will be in this area and to gather testimonies from current users.

  • We just joined an expanded version of MAPS — Minnesota Alliance for Patient Safety — which is looking at clinical safety programs/initiatives that cross over from the hospital setting to nursing facilities and community based settings. With their recent expanded focus, we will be involved at the “ground level” in developing quality strategies and programs that can address care transition clinical issues, as one example.

  • Our Quality Council has been working on tools and resources for all of our members — both nursing facilities and assisted living establishments. We brainstormed on the top categories of immediate educational and resource needs and helped to develop the curriculum for our first Quality Symposium here.

We are so excited to have such a high caliber of both national and state speakers as presenters, and hope they will inspire you to move your own organization forward with quality improvement. With the changing tides, you can’t afford to ignore it.

Copyright ©2012 Patti

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