Embed Size (px)
Citation preview
3/6/2015
1
Quality Improvement Incentive Payment
QIIP
Presenters:
Valerie Cooke
Manager, NF Quality and Research
and
Kim Class, RN
Quality Improvement Coordinator
Minnesota Department of Human Services
March 3, 2015
2
The Lake Superior Quality Innovation Network
The Lake Superior Quality Innovation Network represents Michigan, Minnesota, and Wisconsin, under the Centers for Medicare & Medicaid Services Quality Improvement Organization Program.
Background
� Legislation enacted in 2013� Appropriation equal to 0.8% of all operating
payments� Approximately $2.8 million state share or $7.5
million total including federal match and private pay
� Facilities may earn up to $3.50 per day for one year
� Funds recycled each year � QIIP is intended to encourage quality improvement
(QI) projects
3
3/6/2015
2
QIIP Results so far - Year 1� All but 3 NFs are participating in the first year.
� Most popular QIs – Antipsychotic meds and pain
� 75 (24%) NFs have achieved their target in QIs; however, must maintain improvement at or above target through March 31, 2015 QIs to achieve full payment
� 149 (48%) NFs are trending positively toward their goal
� 86 (28%) are trending in the wrong direction
4
QIIP Results so far – Year 1� 40 NFs opted to work on QOL domains
� Activities and Food domains most popular choice
� 2015 Risk-adjusted Results have been posted in the provider portal
� If QOL domain was selected – you can now figure how much your incentive payment will be for Oct 1, 2015
� Statewide analysis pending
5
How to Participate� NFs select a topic (quality measure) on which to
focus their QI efforts
� May choose ONE MN risk-adjusted Quality Indicator (QI) OR Quality of Life (QOL) domain
� NFs report the quality measure selected through the provider portal by March 31, 2015
� QIIP payment for October 1, 2016 will be based on the amount of improvement between baseline and March 31, 2016 on the selected quality measure
6
3/6/2015
3
What is the Baseline period?� MN risk-adjusted QIs –
� 4 quarters MDS assessment data ending September 30, 2014
� Quality of Life Domains (risk-adjusted)
� Interviews conducted by Vital Research September – November 2014
7
Intervention Period� Quality Indicators
� Now through the 1st quarter of 2016
� Quality of Life
� Now through the QOL survey to be conducted Fall 2015
8
Goal� To improve the measure’s rate by one standard
deviation (SD); or
� To improve to the 25th percentile on the measure’s rate (to the 75th percentile for QIs where a higher rate is better)
9
3/6/2015
4
Example�Prevalence of UTIs
�Baseline Rate – 12.37%
�SD – 2.944%
�Goal using SD – (12.37 – 2.944)
= 9.424%
�25th percentile goal – 6.150%
�Your goal in this case - 6.150%
10
Result� Baseline – 12.37%
� Goal – 6.150%
� Achieved a rate of 7.26%
� Needed to improve rate by 6.22 (12.37 – 6.15)
� Achieved a rate improvement of 5.11 (12.37 –7.26)
� Proportion of goal achieved: 82.15% (5.11/6.22)
� Payment equals $3.50 times .8215 = $2.88 per resident day
11
12
3/6/2015
5
Choosing a QIIP Project
� Review Data
� Choosing an Indicator
What are you currently working on?
What did you choose in the last QIIP?
Are you currently working on a PIPP?
13
DATA
� How to measure improvement
�Provides Baselines
�Assists in Setting Goals
�Determines if improving
� Data Validity-Human Error
14
BASELINE DATA
� Baseline data is a snapshot of how things are when you start the project
� Actual number of residents involved
� Actual number of times a situation happened
15
3/6/2015
6
Frostbite Falls Care Center
� Prevalence of Physical Restraint
� Facility Baseline Score 19.783%
� One Standard Deviation is 1.992%
� Goal Reduce by 1.992 to 17.791%
� Percentile Goal is 0.790%
16
FORMING THE QI TEAM
� Include staff that will be impacted
� Include some staff that aren’t directly impacted
� Include residents, families and even neutral parties
17
GROUND RULES
� All Titles are Left Outside the Room
� All Discussion is Confidential
� Open Listening to Viewpoints, Nonjudgmental
� Timelines, Being Prepared
� All feedback will be constructive
18
3/6/2015
7
DEFINE THE PROBLEM
� Why is it a problem?
� What impact is it having on the residents, staff, facility, etc.
� What are the consequences of not solving this problem?
� What is the difference between the way things are now and the way you want them to be?
19
GOALS
� A goal is a clear statement of the intended improvement and how it will be measured
� Use your goal to stay focused, establish boundaries and define success
� Post your goal at every team meeting
� Goals should be measured by the same method you collected baseline data
20
EXAMPLE of GOALS
� Reduce Physical Restraints from 75% usage to 25% (50% reduction) by November 2015.
� Facility will be Physical Restraint Free by April 2016
21
3/6/2015
8
ROOT CAUSE ANALYSIS
� Look Only for the Reasons the Problem is Happening
� Brainstorm and get Everyone’s Opinion without Judging
� “Sticky Note” Method if People are Reluctant to Share
� Keep asking Why
� Remember, You want Lasting Solutions, not Quick Fixes
22
Example of Problem:
� The Minnesota QIIP report shows we scored the highest in the state for physical restraints
23
What is your next step?
� Review Systems and Processes
�Resident Safety
�Organizational Ethics
�Regulatory Compliance
�Risk Management
�Resources
�Budget
�Staff Education/Orientation
�Resident Records
�Residents Rights
�Resident Satisfaction/Quality of Life
24
3/6/2015
9
EXAMPLE:
WHAT’S DISCOVERED
� Systems and Processes Promote Physical Restraint
� Belief Physical Restraints promote safety
� Staff lack knowledge regarding restraints
� Families insist on Restraints use
� Poor Quality of Life
25
EXAMPLE:
Continue Asking Why?
�Ask why we use restraints?�Ask why are restraints viewed as safe?�Ask what education is provided on
restraints�Ask why the families insist on restraint
use�Continue to ask why until all reasons
are discovered
26
EXAMPLE:
Possible Root Causes:
� No systems or processes to reduce restraints
� No education in place to address dangers of physical restraints
� No education on resident safety
� No plan for restraint reduction
27
3/6/2015
10
Root Causes
� Once the true causes have been discovered, strategies can be developed to improve communication, clarify staff expectations and solicit resident input
28
Creating an Action Plan
� What are we doing?
� What should we be doing?
� What should we be doing next?
� How should we be doing it?
� What should we not be doing?
29
Action Plan
� Identifies Short and Long Term Goals
� List Objectives
� Identifies Roles
� Lists Strategies
� Identifies Timelines and Measures
� Implementation/Evaluation
30
3/6/2015
11
MONITOR
� How will you Monitor Systems?
� Who is Responsible?
� How Often?
� How will you Assess Strategies?
31
EVALUATION
� How will you Evaluate?
� Who Evaluate?
� How Often?
� Who is Responsible for Reviewing Findings?
� How will You Evaluate Success?
32
QUALITY IMPROVEMENT TIPS
� Look for Ways to Improve.
� Don’t Jump to Conclusions without Proof
� Look for the Real Causes of Problems
� Consider the Impact of Your Actions
� Stop Departmentalizing Issues
33
3/6/2015
12
MORE TIPS
� Consider what each department can do to solve problems
� Implement change in a small area
� Realize that everyone has equal responsibility to the resident
34
CREATIVE THINKING
� You cannot solve a problem if you come to the table with the same thinking that created the problem
� Thinking Out of Box inspires new ideas and learning opportunities
35
Contact Information
Valerie Cooke, Manager, Quality and Research, NFRP
651-431-2263
Kim Class, RN QI Coordinator, NFRP
651-431-2274
Teresa Lewis, LTC Senior Research Associate, NFRP
651-431-4208
36
3/6/2015
13
Join the National Nursing Home Quality Care Collaborative
38
What’s in it for me?
• Free expertise and practical assistance with the goal of improving systems of care that lead to better quality outcomes for your nursing home residents
• Free access to the latest evidence-based practices and resources to support overall nursing home quality
39
What’s in it for me?
• Free educational opportunities, webinars, in-person sessions, conference calls, etc., including practical assistance to help you succeed in efforts you are already doing ( PIPP, QIIP, QAPI implementation, improvement in 5 Star rating, and composite score)
3/6/2015
14
40
What’s in it for me?
• Free opportunities to come together in collaborative educational sessions for learning, sharing, and networking
• Free quarterly data reports to help you track your progress
41
To Join
• Go to the electronic participation agreement-http://www.cvent.com/d/y4qbg4
• Complete and sign Participation Agreement (must be signed by CEO, COO, Administrator, or Owner
• Submit the participation agreement electronically
42
To Join
For questions about the NNHQCC contact:
Kristi Wergin
Program Manager, Stratis Health
952-853-8561
3/6/2015
15
43
Questions?
This material was prepared by the Lake Superior Quality
Innovation Network, under contract with the Centers for
Medicare & Medicaid Services (CMS), an agency of the
U.S. Department of Health and Human Services. The
materials do not necessarily reflect CMS policy.
11SOW-MI/MN/WI-C2-15-37 022715
