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SUCCESSFUL PERFORMANCE IMPROVEMENT The Heart of Financial and Clinical Success
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OBJECTIVES
§ Understanding what to measure and how to apply
§ Distributing information for maximum effect
§ Meeting regulatory requirements in a busy world
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WHAT YOU MAY NOT KNOW § DMEPOS Supplier Standards
§ Medicare Quality Standards
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DMEPOS SUPPLIER STANDARDS § DMEPOS Supplier Standards
• 30 standards required by Medicare
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MEDICARE QUALITY STANDARDS
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MEDICARE QUALITY STANDARDS (CONT.)
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WHAT’S MEASURED CAN BE IMPROVED!
§ Only what is measured can be affected
§ The unknown is an abyss of knowledge waiting to be tapped
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OLD RULES APPLY
§ 80/20 rule in effect always
§ 80% of your time and resources is spent on 20% of your clients/patients
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DO YOU KNOW? § What percentage of your initial setups require reeducation?
§ How many after-hours calls are education-related?
§ How much product is shipped? • How accurate is that delivery?
§ How many no-shows do you have?
§ What is the percentage of refits? • Is it tied to certain masks?
§ Are billing errors cyclic?
§ What are you main slip, trips and falls?
§ How often are you replacing equipment?
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ELEMENTS OF REVIEW
Ensure each item has the following documented for each:
§ A description of indicator(s) to be monitored/activities to be conducted
§ Frequency of activities
§ Designation of who is responsible for conducting the activities
§ Methods of data collection
§ Acceptable limits for findings or thresholds
§ Who will receive the reports
§ Written plan of correction when thresholds are not met Plans to re-evaluate if findings fail to meet acceptable limits
§ Any other activities required under state or federal laws or regulations
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EXAMPLES
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EXAMPLES
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EXAMPLES
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EXAMPLES
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EXAMPLES
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EXAMPLES
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EXAMPLES
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DEFINING PI ACTIVITIES
TO BE DEFINED SUGESTION
A description of indicator(s) to be monitored/activities to be conducted
What are you going to be studying? Identify a problem-prone aspect of your practice and define what will be monitored.
Frequency of activities How often will this be looked at? Monthly? Quarterly? Pick a frequency appropriate for the specific activity.
Designation of who is responsible for conducting the activities
Your PI Program should designate a person responsible for this initiative. This may be a part of personnel job descriptions or it may be individualized to the particular study.
Methods of data collection How will you collect data and from where? Adverse event reports? Near-miss incidents? Documentation audit? 10% of all new patients? All new personnel files from the past quarter?
Acceptable limits for findings What is an acceptable threshold for the objective? 100%? 90%? You will need to decide what is appropriate for the objective. The threshold may not be a number. For example, with complaints or incidents the acceptable limit may be no development of a negative trend.
Designation of who will receive the reports
Who will the PI information be reported to?
Plans to re-evaluate if findings fail to meet acceptable limits
It is possible that your PI Program could reveal things you don’t like about your organization, that’s why it’s being done! Develop a plan to handle the occurrence of a finding below its established threshold, and continue until you get it right!
Once you have decided what to audit or monitor, define each PI activity with the following at minimum:
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WHAT TO MEASURE Ensure all PI data is utilized to improve performance. Each area below should have data collected and analyzed. Prepare an annual report for every year identifying the results for all items. Staff and BOD/Owner should be involved and knowledgeable about PI program and results. § Adverse events
• Incidents § Client/patient complaints § Client/patient records § Satisfaction surveys
• Client • Employee • Referral source
§ Billing and coding errors § At least one important aspect related to care/service provided
§ Effectiveness of the compliance program
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WHAT TO MEASURE (CONT.)
If using contract services the following must be documented separately for those services, i.e., 1099 employees. This would include contract management of required billing documentation. § Satisfaction surveys § Record reviews § On-site observations and visits § Client/patient comments § Other Performance Improvement activities
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CORRECTIVE ACTION PLANS
§ If a PI activity fails to meet acceptable limits for findings, a written plan of correction must be completed
• A written plan of correction should document
• Issues found
• Probable causes
• Corrective action(s) to take
• When findings will be re-evaluated
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ANNUAL PI SUMMARY
§ Another key ingredient of a PI plan is a written annual summary of the PI program
• Summarize the results of each PI activity conducted and any corrective actions taken
• Leadership should receive and review the annual PI summary
• Graphing results for Trends
• Financial impact
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§ Performance Improvement Program
§ Quality Improvement Program
§ Continuous Quality Improvement
§ Facsimiles
WHAT IS REQUIRED TO MEET MEDICARE REQUIREMENTS
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§ Why do you do Performance Improvement/Quality Improvement?
§ What metrics do you know?
§ What metrics should you know?
DOES PERFORMANCE IMPROVEMENT COST OR ADD VALUE
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PI THAT DOESN’T ADD VALUE
§ PI activities repeated over and over again, that always meet goals and never change
§ Monitoring for things that you already know are done well
• Ok to monitor annually to ensure no new problems have originated
§ PI activities that don’t change to meet the needs of the organization
• If monitoring complaints and you see a trend, change the focus of the activity to fix the negative trend
§ Auditors who audit their own work
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PI THAT ADDS VALUE
§ PI activities that view the fires that are put out, or band-aids that are slapped on, as temporary fixes and studies them for permanent improvement
§ PI that compares prior activity results for positive or negative trends
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HOW TO AFFECT THE BOTTOM LINE
§ Cut cost
§ Increase reimbursement
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ACHCU
§ PI program offered through ACHCU
• Under tools
§ https://achcu.com/home
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YES, I’M REQUIRED TO DO PI, AND I DECIDE WHAT VALUE IT BRINGS
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LINKS
§ https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Downloads/Final-DMEPOS-Quality-Standards-Eff-01-09-2018.pdf
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QUESTIONS?
