Effective quality assurance and performance improvement (QAPI) is critical to our national goals to improve care for individuals and improve health for populations, while reducing per capita costs in our healthcare delivery system. We have the opportunity to accomplish these goals in each local nursing home with the aid of QAPI tools and the establishment of an effective QAPI foundation. Nursing homes are in the best position to assess, evaluate, and improve their care and services because each home has firsthand knowledge of its own organizational systems, culture, and history. Effective QAPI leverages this knowledge to maximize the return on investments made in care improvement.
In June, CMS finalized a collection of December 2014 proposals for its Medicare Shared Savings Program (MSSP), taking another deliberate step toward a value-based payment system that rewards quality over quantity of care. While the title of the rule set—Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations—may align primarily with one of the longest running tracks in CMS’ accountable care organization (ACO) program, its provisions implicate all partnerships currently participating in the program, as well as those slated to join its ranks in 2016.
First comes getting each month’s claims out the door. Then comes dealing with payer updates, system changes, and so on. The last thing anyone wants to add to their plate is an Additional Documentation Request (ADR) from a fiscal intermediary (FI) or Medicare Administrative Contractor (MAC). But ignoring ADRs or putting them off until there’s time to address them will only pose bigger problems down the line.
From the questions Diane Brown, director of post-acute education at HCPro in Danvers, MA has been receiving from the industry, billing, and documentation will be the initial issue with ICD-10 post-implementation.
SNFs that thrive on post-surgery joint replacement care are facing a new payment model that could fuel a monumental shift in the way they approach service delivery and internal quality data assessment. In July, CMS proposed a Comprehensive Care for Joint Replacement (CCJR) model—a groundbreaking bundled payment system for lower extremity joint replacements (LEJR), including those for hips and knees. The prospective program, which includes provisions expressly aimed at SNF performance, would open with a five-year test run and mandate compliance for all qualifying providers in 75 geographical areas across the country.