COVER STORY Solutions to QAPI Program Challenges
An established QAPI program might face problems as it matures. To help overcome these obstacles, Cindy King, RN, associate vice president, clinical, quality and compliance, for ASC management and development company Health Inventures in Westminster, Colorado, advises ASCs to take a number of steps.
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Schedule QAPI meetings well in advance and get buy-in from the majority of members on dates and locations;
Send all correspondence—such as the agenda and other detailed informa- tion, with the exception of confidential information—within approximately one week of the meeting;
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Establish doable goals as these will create the framework for an effective meeting;
Ensure that meetings start and end on time. The chair should maintain control of topics and time and elicit physician input;
Use or reference the pre-work supplied prior to the meeting during the meet- ing to reinforce the need for participants to spend time reviewing this material that is integral to accomplishing desired results;
■ Review the date, time and location of the next meeting before adjournment; and ■
Finally, follow up with accountable people in between meetings to check on progress.
pharmacy consultant will not find many issues, but you’re still going to evaluate the reports from your phar- macist as part of your QAPI process. It’s ongoing evaluation of provided services you are performing all of the time. Another example is peer review. You perform this on an ongoing basis regardless of whether there are any is- sues or not.” Another area is quality measures, Kirchner says. “The ones I recommend you definitely have are the ones that have been approved by the National Quality Forum. They are endorsed measures and we started reporting them in October 2012. They are: pa- tient falls, patient burns, hospital transfer and admission; wrong site/ wrong side/wrong patient/wrong pro- cedure/wrong implant and prophylac- tic IV antibiotic timing (within one hour of procedure). If you don’t report these measures, you can lose up to 2 percent of your Medicare reimburse- ment in 2014.”
14 ASC FOCUS MARCH 2013
says. “Let’s say your pharmacy con- sultant finds several medications are expired. You may benefit from doing a QI study on that issue. Same thing if you have complications and infections. You are going to want to study those in greater depth by identifying causes and ways to improve your performance to reduce their occurrence.” You will also want to benchmark
your results, Stinchcomb says. “That’s going to help ensure that you have a ro- bust QAPI program,” she says. “ASCs with robust programs benchmark in- dicators and determine action based on benchmark results. Many facilities collect the benchmark data but never take it to the next step of evaluating the result and determining if they can im- prove. They should go that extra step.” King says an ASC should task the QAPI committee with providing ongo- ing education about the program’s ef-
ASCs with robust programs benchmark indicators and determine action based on benchmark results”
—Debra Stinchcomb, Progressive Surgical Solutions, San Diego Don’t just stop with those mea-
sures, Stinchcomb says. “There are a ton of things you could measure, but you don’t want to measure just to mea- sure,” she says. “You want to measure to make a difference. For example, let’s say that all of a sudden you have a problem with returns to the OR. Why? That would be an indicator to measure. In another example, perhaps you have a high number of cancellations. That is an indicator that you are going to want to measure for a while so you can evaluate and implement action on the trends causing the cancellations.” Another critical piece to include is quality improvement (QI) studies, Stinchcomb says. “These are meant to study something more in-depth,” she
forts. “Other medical-leadership com- mittees, such as the medical executive and clinical operations committees, and on-site management team mem- bers need to obtain an understanding of and appreciation for the implemen- tation of a comprehensive program on an ongoing basis so that these in- dividuals can maintain a more unified, leadership approach,” she says. “All medical staff members, other types of credentialed practitioners, employees and those individuals providing con- tracted services also need to receive routine education, training and feed- back on a periodic basis in order to achieve a better understanding of cur- rent facility policies, procedures and other processes.”
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