Quality Assurance and Performance Improvement (QAPI)

Quality care is the heart of what we do, and QAPI is the road to get there! You may be thinking that is easier said than done. The resources below have been gathered to assist you in achieving your facility goals for quality care outcomes. Need another reason to better understand QAPI? As value-based payment becomes a reality, facilities are required to demonstrate the quality of care to consumers and payers, continuously improving efficiency and resident outcomes. Learn how you can get ahead of the game with helpful resources.

  • CASPER Reporting User’s Guide for MDS Providers UPDATED (1/20)

    By QTSO - January 04, 2020
    Provides information and instructions pertaining to CASPER Reporting, including accessing Final Validation Reports.
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  • Five-Star Technical User's Guide UPDATED AGAIN (10/19)

    By CMS - October 28, 2019

    CMS created the Five-Star (5-Star) Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily. The Five-Star Quality Rating System Technical Users' Guide provides in-depth descriptions of the ratings and the methods used to calculate them. Updated twice in October 2019.

    October 2019 Revisions

    In October 2019, several changes were made to the Nursing Home Compare website and the Five-Star Quality Rating System. These changes affected the health inspection and quality measure domains. This section provides details on these changes.

    Ratings changes for facilities that receive the abuse icon: To make it easier for consumers to identify facilities with instances of non-compliance related to abuse, starting in October 2019, CMS added an icon to highlight facilities that meet either of the following criteria: 

    1. Harm-level abuse citation in the most recent survey cycle: Facilities cited for abuse where residents were found to be harmed (Scope/Severity of G or higher) on the most recent standard survey or on a complaint survey within the past 12 months. 
    2. Repeat abuse citations: Facilities cited for abuse where residents were found to be potentially harmed (Scope/Severity of D or higher) on the most recent standard survey or on a complaint survey within the past 12 months and on the previous (i.e., second most recent) standard survey or on a complaint survey in the prior 12 months (i.e., from 13 to 24 months ago). 

    Nursing homes that receive the abuse icon have their health inspection rating capped at a maximum of two stars. Due to the methodology used to calculate the overall rating, the best overall quality rating a facility that receives the abuse icon can have is four stars. 

    Removal of quality measures related to pain: CMS removed two quality measures (QMs) from the Nursing Home Compare website and the Five-Star Quality Rating System in October 2019. These measures are: 

    • Percentage of short-stay residents who report moderate to severe pain. 
    • Percentage of long-stay residents who report moderate to severe pain. 

    As a result of dropping these two measures, the cut-points for the long-stay, short-stay, and overall QM ratings changed. These changes were made to maintain, as close as possible, the same distribution of short-stay and long-stay QM ratings as were posted on Nursing Home Compare in July 2019. 


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  • AHRQ 2019 Chartbook on Patient Safety (10/19)

    By AHRQ - October 28, 2019

    This Chartbook on Patient Safety includes a section with results from the National Nursing Home Survey on Patient Safety:

    National Healthcare Quality and Disparities Report

    This Patient Safety chartbook is part of a family of documents and tools that support the National Healthcare Quality and Disparities Report (QDR). The QDR includes annual reports to Congress mandated in the Healthcare Research and Quality Act of 1999 (P.L. 106-129). This chartbook includes a summary of trends across measures of patient safety from the QDR and figures illustrating select measures of patient safety. A PowerPoint version is also available that users can download for presentations.

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  • SNF QRP October 2019 Nursing Home Compare Refresh (10/19)

    By CMS - October 28, 2019

    The October 2019 Nursing Home Compare Refresh, including quality measure results based on SNF QRP data submitted to CMS, is now available. For this refresh SNF QRP assessment-based measures performance scores will be based upon data submitted to CMS between Q1 2018 – Q4 2018 (1/01/18 – 12/31/18); claims-based measures performance scores will be based upon SNF Prospective Payment System (PPS) claims dated between Q4 2016 and Q3 2018 (10/01/16 – 9/30/18).

    CMS will no longer refresh the measure Percentage of Residents/Patients with Pressure Ulcers that are New or Worsened (NQF #0678), under the SNF QRP. The October refresh, as well as all subsequent refreshes of this quality measure data will be solely related to the CMS Nursing Home 5-Star Ratings.

    We are implementing the annual refresh of the SNF QRP claims-based measures during the October 2019 refresh of NH Compare. The annual refresh will include updates to the Medicare Spending per Beneficiary (MSPB) and Discharge to Community (DTC) measures. As previously announced, we have updated the methodology used to assign provider performance categories to the DTC measure. Additionally, this refresh includes the inaugural posting of provider performance scores for the Potentially Preventable Readmissions (PPR) measure, which were previously suppressed.

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  • CMS Dementia Care Resources Webpage (10/19)

    By CMS - October 25, 2019

    CMS has established a Dementia Care Resources page to provide information that was previously housed at the National Nursing Home Quality Improvement Campaign. Additional resources are available through the QIO program.

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  • Infection Control in Healthcare Personnel Guidelines (Part I) - Updated (10/19)

    By CDC - October 23, 2019
    Preventing the transmission of infectious diseases among healthcare personnel (HCP) and patients is a critical component of safe healthcare delivery in all healthcare settings. Today, CDC published Infection Control in Healthcare Personnel: Infrastructure and Routine Practices for Occupational Infection Prevention and Control Services, an update of four sections of Part I of the Guideline for infection control in health care personnel, 1998 (“1998 Guideline“) and their corresponding recommendations in Part II:

    ·  C. Infection Control Objectives for a Personnel Health Service

    ·  D. Elements of a Personnel Health Service for Infection Control

    ·  H. Emergency-Response Personnel

    ·  J. The Americans With Disabilities Act

    The updated recommendations are aimed at the leaders and staff of Occupational Health Services (OHS) and the administrators and leaders of healthcare organizations (HCO) and are intended to facilitate the provision of occupational infection prevention and control (IPC) services to HCP and prevent the spread of infections between HCP and others. Additional updates to the 1998 Guideline are underway and will be published in the future. Updates in Part I include: 

    ·  a broader range of elements necessary for providing occupational IPC services to HCP;

    ·  applicability to the wider range of healthcare settings where patient care is now delivered, including hospital-based, long-term care, and outpatient settings such as ambulatory and home healthcare; and

    ·  expanded guidance on policies and procedures for occupational IPC services and strategies for delivering occupational IPC services to HCP.

    New topics include:

    ·  administrative support and resource allocation for OHS by senior leaders and management,

    ·  service oversight by OHS leadership, and

    ·  use of performance measures to track occupational IPC services and guide quality improvement initiatives.  

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  • Infection Prevention and Control: CDC Prevention Epicenters Program Innovation and Best Practices for PPE Use (10/19)

    By CDC - October 23, 2019

    Unrecognized spread of germs from healthcare personnel (HCP) contamination occurs every day in healthcare settings, posing a risk to patients and HCP alike. Recent Ebola virus outbreaks demonstrated that the potential for transmission of any pathogen in healthcare settings poses an immediate and serious threat. 

     Preventing the spread of germs in healthcare is essential to protecting the health of patients and HCP. This International Infection Prevention Week, the CDC Prevention Epicenters Program is pleased to announce a groundbreaking new journal supplement, “Personal Protective Equipment for Preventing Contact Transmission of Pathogens: Innovations from CDC’s Prevention Epicenters Program,” composed of 14 in-depth studies, published in this month’s Clinical Infectious Diseases. This research provides insights from recent personal protective equipment (PPE) work in U.S. healthcare settings. It provides evidence to improve routine use of PPE, and to prevent contact transmission of Ebola and other infectious diseases in healthcare settings.

    All healthcare settings can benefit from improvements in PPE use and design. PPE plays an important role in preventing the spread of infectious diseases in healthcare settings, but its optimal design and use need to be informed by dedicated research to achieve the reliability and effectiveness needed to protect patients and HCP. 

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  • AHRQ Team Develops Definition of 'Omissions of Care' for LTC (10/19)

    By AHRQ - October 18, 2019

    Adverse events and poor health outcomes are continuing challenges for nursing home residents and staff. Research has shown that many resident harms are avoidable and may be caused by situations in which residents do not receive needed care, often called omissions of care. Omissions of care research in nursing home settings is limited and definitions of omissions of care vary. Therefore, AHRQ has developed a definition of omissions of care for nursing homes intended to be meaningful to stakeholders, including residents and caregivers, and actionable for research or improving quality of care. 

    The new definition, intended as a meaningful and actionable reference for researchers, nursing home residents and caregivers, states: 

    “Omissions of care in nursing homes encompass situations when care—either clinical or nonclinical—is not provided for a resident and results in additional monitoring or intervention or increases the risk of an undesirable or adverse physical, emotional, or psychosocial outcome for the resident.”
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  • CMS Section GG Training Videos: GG0130A, GG0110, GG0170C, GG0130B, Decision Tree for GG0130/GG0170 (10/19)

    By CMS - October 18, 2019

    These apply to all four QRP programs, including the SNF QRP:

    • Coding GG0130A. Eating (6:19)The Centers for Medicare & Medicaid Services is releasing a short video tutorial to assist providers with coding GG0130A. Eating. This 6-minute video is designed to provided targeted guidance using simulated patient scenarios.
    • GG0110 Prior Device Use with Information From Multiple Sources. This 4-minute video demonstrates how a caregiver can utilize information collected from multiple scenarios to accurately code GG0110. Prior Device Use. 
    • Decision Tree for Coding Section GG0130. Self-Care and GG0170. Mobility. This 12-minute video demonstrates how to apply the six-point coding scale to GG0130. Self-Care and GG0170. Mobility using GG0170D. Sit to stand as an example.
    • Coding GG0170C. Lying to sitting on side of bed This 4-minute video demonstrates how to distinguish between Code 02, Substantial/maximal assistance and Code 03, Partial/moderate assistance when coding GG0170C. Lying to sitting on side of bed.
    • Coding GG0130B. Oral HygieneThis 4-minute video demonstrates how to distinguish between Code 05, Set-up or clean-up assistance and Code 04, Supervision or touching assistance when coding GG0130B. Oral Hygiene. 
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  • Consensus Recommendations to Prevent Secondary Fractures in Adults 65+ with Osteoporosis (10/19)

    By Hinda and Arthur Marcus Institute for Aging Research - October 14, 2019

    Coalition Reaches Consensus on Recommendations to Prevent Secondary Fractures in Adults 65+ with Osteoporosis

    Recommendations target all health care professionals who participate in the care of older adults at risk for osteoporotic fractures

    BOSTON (October 2, 2019) - A multistakeholder coalition assembled by the American Society for Bone and Mineral Research (ASBMR) has issued clinical recommendations for the optimal prevention of secondary fracture among people aged 65 years and older with a hip or vertebral fracture - the most serious complication associated with osteoporosis. Douglas P. Kiel, M.D., M.P.H., Director of the Musculoskeletal Research Center in the Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife and Professor of Medicine at Harvard Medical School, is senior author on the report and served as co-leader of the project. The recommendations were published last month in the Journal of Bone and Mineral Research to coincide with the annual meeting of the ASBMR where Dr. Kiel was honored with the 2019 Esteemed Frederic C. Bartter Award. This prestigious award is bestowed upon an ASBMR member in recognition of outstanding clinical investigation in disorders of bone and mineral metabolism. 

    The coalition developed 13 recommendations strongly supported by the empirical literature and recommends increased communication with patients regarding fracture risk, mortality and morbidity outcomes, and fracture risk reduction.
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  • SNF QRP: 2Q 2019 FAQs (10/19)

    By CMS - October 13, 2019
    A new Question and Answer (Q+A) document is now available in the "Downloads" section of the SNF Quality Reporting Program FAQs webpage. The Q+A document reflects frequently asked questions that were received by the SNF QRP Help Desk during the second quarter (Apr - Jun) of 2019.
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  • MDS 3.0 Quality Measures (QM) User's Manual V12.1 Re-posted (10/19)

    By CMS - October 09, 2019

    Nursing Home Quality Measure Changes

     The following nursing home quality measures have been removed:

    ·        Percentage of short-stay residents who report moderate to severe pain.

    ·        Percentage of long-stay residents who report moderate to severe pain.

    This change supports the federal initiative to reduce opioid utilization by seeking to prevent a potential scenario where the performance of a facility on the pain quality measures may inappropriately contribute to their decision to seek the administration of an opioid. 

    MDS 3.0 QM User’s Manual Version 12.1 Now Available

    The MDS 3.0 QM User’s Manual Version 12.1 has been posted. The MDS 3.0 QM User’s Manual V12.1 contains detailed specifications for the MDS 3.0 quality measures. The MDS 3.0 QM User’s Manual V12.1 can be found in the Downloads section of this page and the MDS 3.0 QM User’s Manual V12.0 has been moved to the Quality Measures Archive page.

    One file related to the MDS 3.0 QM User’s Manual has been posted:

    1.      MDS 3.0 QM User’s Manual V12.1 contains detailed specifications for the MDS 3.0 quality measures.

    2.      Quality Measure Identification Number by CMS Reporting Module Table V1.7 documents CMS quality measures calculated using MDS 3.0 data and reported in a CMS reporting module.  A unique CMS identification number is specified for each QM.

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  • SNF QRP Measure Calculations and Reporting User's Manual Update (9/19)

    By CMS - September 05, 2019

    The Skilled Nursing Facility Quality Reporting Program Measure Calculations and Reporting User’s Manual Version 3.0 has been posted. The Skilled Nursing Facility Quality Reporting Program Measure Calculations and Reporting User’s Manual Version 3.0 contains detailed specifications for the assessment- and claims-based quality measures reported under the SNF QRP. The manual can be found below and the Skilled Nursing Facility Quality Reporting Program Measure Calculations and Reporting User’s Manual Version 2.0 has been moved to the Quality Measures Archive page.

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  • OIG Audit Finds Staff Didn't Always Comply With Care Plan for Residents With UTI at One NF (6/19)

    By OIG - June 19, 2019

    Princeton Place Did Not Always Comply With Care Plans for Residents Who Were Diagnosed With Urinary Tract Infections (A-06-17-02002)

    Princeton Place did not always provide services to Medicaid-eligible residents diagnosed with UTIs in accordance with their care plans, as required by Federal regulations. Specifically, Princeton Place staff did not always document that they monitored the residents' urine appearance at the frequencies specified in their care plans. Princeton Place did not have policies and procedures to ensure that its staff provided services in accordance with its residents' care plans. As a result of Princeton Place not following residents' care plans, the residents were at increased risk for contracting UTIs and for incurring complications from UTIs, including requiring hospitalization.

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  • SNF QRP: Updates to SNF Provider Preview Reports (6/19)

    By QTSO - June 03, 2019

    Effective 6/1/19, there will be enhancements to the upcoming Provider Preview Reports. The next SNF Provider Preview Report is scheduled for August 1, 2019. The updates will include:

    • Pressure Ulcer Measure Transition

     -The current pressure ulcer measure, Percent of Residents or Patients with Pressure Ulcers That Are New or Worsened (Short Stay) (NQF #0678), will last appear on the May 2019 SNF Provider Preview Report. Starting August 1, 2019, this measure will be removed.
     -The new pressure injury measure, Changes in Skin Integrity Post-Acute Care, will first display on the August 2020 Provider Preview Report.

    • Ending suppression of the PPR claims-based measure:  
     -Potentially Preventable 30-Day Post-Discharge Readmission Measure for Inpatient Rehabilitation Facility Quality Reporting Program
    • Displaying measure short names in place of their long names and many aesthetic changes to field labels and headings.

    • Update of the Discharge to Community Measure  
     -The refined measure results for the Discharge to Community Measure will be reflected for the first time in the fall 2019 Quarterly Refresh for the Nursing Home Compare website and the related August 2019 Provider Preview Reports.

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