The Quality Assessment and Performance Improvement Program requirements discussed here can be found in the Federal Register / Vol. 73, No. 109 / Thursday, June 5, 2008 / Rules and Regulations (PDF file attached to this discussion). The CoPs (Conditions of Participation) reflected in the June 5, 2008 rule developed a set of core requirements for hospice services that encompass the following:
- patient rights,
- comprehensive assessment,
- patient care planning and
- coordination by a hospice interdisciplinary group (IDG).
Overarching these requirements is the Quality Assessment and Performance Improvement (QAPI) program that builds on the philosophy that a provider’s own quality management system is key to improved patient care performance. The objective is to achieve a balanced regulatory approach by ensuring that a hospice furnishes health care that meets essential health and quality standards, while ensuring that it monitors and improves its own performance.
This latest revision to the CoPs is part of a larger effort to bring about improvements in the quality of care furnished to hospice patients and their families through an outcome-oriented approach to patient care. The revisions focus on the core elements of hospice care that are necessary to achieve positive patient outcomes to meet the growing challenges associated with the changing hospice care environment such as increasingly diverse patient populations and care settings.
The final standard requires hospices to include, as part of the information gathered by the comprehensive assessment, data elements to allow hospices to measure patient outcomes. This standard proposed that the data elements would be collected and documented in the same manner for all patients in order to ensure the accuracy and consistency of the data. Hospices would be required to use the data in individual care planning and the quality assessment and performance improvement program described in paragraph § 418.58. The rule does not require hospices to use any specific patient outcome measures or data elements.
At the same time, the rule does not expect hospices to limit their QAPI-related data collection efforts to the data collected in the patient assessments. Data collection must look beyond patient assessment data to examine all facets of a hospices operation, from contract services to volunteer retention rates to adverse events. Rather than limiting the amount of useful data available to hospices, this requirement simply ensures that patient level data are included as part of the broader data collection program.
The QAPI program requirements were developed based upon the following principles for hospice care:
- Focus on the continuous, integrated health care process that a patient/family experiences across all aspects of hospice care, and on activities that center around patient assessment, care planning, service delivery, and quality assessment and performance improvement;
- Use a patient-centered, interdisciplinary approach that recognizes the contributions of various skilled professionals and other support personnel and their interaction with each other to meet the patient’s needs;
- Incorporate an outcome-oriented quality assessment and performance improvement program;
- Facilitate flexibility in how a hospice meets performance expectations;
- Require that patient rights are ensured; and
- Use performance measurement systems to evaluate and improve care.
Replies