The University of Minnesota is seeking four volunteer nursing homes in Minnesota to participate in a national study to help develop and test the Quality Assurance and Performance Improvement (QAPI) program. As previously reported in Quality in Action, the Centers for Medicare and Medicaid Services (CMS) is preparing to launch a new quality initiative for nursing homes directed specifically at implementing the Quality Assurance and Performance Improvement (QAPI) program mandated by the Affordable Care Act. QAPI requires that nursing homes further develop and have in place a program to identify potential and extant problems and implement systemic strategies to address them as well as to incorporate a more rigorous approach to system-wide performance improvement. In order to gain practical experience before the full national rollout, CMS has contracted with the University of Minnesota and Stratis Health to conduct a demonstration project. Rosalie A. Kane, a long-time leader in nursing home quality, is the project director.

The overall intent is to select a total of sixteen facilities in four states—California, Florida, Massachusetts, and Minnesota—to participate in the demonstration. Participants will receive individually-tailored technical assistance, training, and materials to assist them in their QAPI development. They will also participate in a learning collaborative comprised of leaders from the participating facilities, with in-person collaborative meetings rotating across the states where they can interact with peers and provide input for the national program.

Please consider the opportunity to be on the ground floor in helping shape QAPI in nursing homes. CMS intends to begin a QAPI demonstration before a QAPI regulation is written and to use the experience of the demonstration to help inform the rule-making process. A two-year demonstration is planned to begin shortly after Labor Day 2011. Participating nursing homes will be identified by the end of July 2011.

Interested parties are encouraged to join an informational conference call on any of the following dates and times:

Friday, June 10, 11:00 a.m. ET
Monday, June 13, 4:00 p.m. ET
Wednesday, June 15, noon ET
Wednesday, June 15, 3:00 p.m. ET
Thursday, June 16, 11:00 a.m. ET

Registration for the informational calls is highly appreciated. To register for a call, dial 612-624-5171 or email Amanda Lambrecht at lamb@umn.edu.

To join the call, dial 1-866-352-3799, then enter the code *6245171*

Interested facilities or long-term care multi-facility organizations with facilities in the state are welcome to join. Nursing homes need to complete a short application form to be considered—that is because the demonstration seeks variation in the participant group, including different experiences with quality assurance activities. There is no right or wrong answer to the items, and completing the form does not commit the nursing home to a decision to participate. Applications must be submitted by June 30, 2011. Additional information about the demonstration, common questions and answers, and the application can be found on the Care Providers of Minnesota quality page, under the heading “QAPI Initiative.”

Participating facilities will receive tailored technical assistance as they build their own QAPI plan. They will also become part of a national collaborative, and will meet with their counterparts in person four times during the two years of the program. The plan is that the initial experience in the demonstration homes will help shape the program going forward. The University of Minnesota and Stratis are also assembling or developing tools and resources to assist facilities with QAPI; facilities participating in the demonstration will be the first to use and give feedback on the materials developed.

Within the limitations of working with a small number of nursing homes, the organizers are striving to identify a group of volunteering facilities that reflect the wide variation that exists in nursing homes. For example, we anticipate that the final group will include representation from both large and small facilities, chain-owned and independent facilities, not-for-profit and for profit facilities, and facilities with different kinds of prior experience in quality assurance and quality improvement activities; they will also try to include some nursing homes in both rural and urban settings. The QAPI program needs to work well in all facilities regardless of their size, services, or prior QAPI experience. It is, therefore, expected that more will be learned from the demonstration about best QAPI practices if the participating facilities are a varied group. Participating facilities will have the opportunity to develop their QAPI program before formal requirements are enunciated and help shape the program. They will have a chance to hone skills and develop internal resources with external assistance.

It is expected that the QAPI program will include the following: a written plan for a continuous and comprehensive program with a design and scope suited to the facility; a governance and leadership structure that provides accountability and sets expectations for the program; feedback and data systems for monitoring with information drawn from multiple sources; performance improvement projects; and an approach to quality that includes systematic analysis of problem areas and systemic action to address such problems. Nursing homes in the state of Minnesota are encouraged to explore the opportunity of participating.

Doug Beardsley
952.851.2489
dbeardsl@careproviders.org