Simione™ Healthcare Consultants

The Quandary Over Quality: Take the Mystery Out of Performance Improvement, Data-Driven Quality Goals

Discover Simione's QAPI Outsourcing Solutions & Expert Consulting Resources to Build Momentum & Sustain Operational Excellence

Since the Centers for Medicare and Medicaid Services (CMS) made it mandatory for home health agencies (2018) and hospices (2008) to implement Quality Assessment and Performance Improvement (QAPI) programs, many agencies still find the process cumbersome, confusing, and difficult to sustain.

Efforts to deploy data-driven quality initiatives, including the development of performance improvement plans, can be daunting without the right expertise and technology to gather and analyze data, prepare reports, and monitor efforts, according to Kim Skehan, Director, Compliance, Regulatory and Quality at Simione Healthcare Consultants.

“It’s common for home health or hospice agencies to experience difficulty with QAPI program development, sustained implementation and demonstration of outcomes improvement, and generally, agencies struggle at one of two timepoints,” Skehan said, having led quality efforts as an agency and state association executive and national consultant for more than 30 years.

“Some agencies have difficulty from the outset understanding program basics, including how to target appropriate areas for quality improvement: which metrics are important, where to find the data, how to present it in an acceptable format and how to develop realistic improvement projects around it,” Skehan said.

“Other agencies may spend a lot of staff time up front to gather the data, identify problem areas and develop performance improvement projects – but many lose momentum over time, and they drop the ball on ongoing monitoring efforts.”

J’non Griffin, President of Home Health Solutions, a Simione Coding Company, and Simione’s partner in delivering outsourced QAPI solutions, agrees.

“The process tends to bog down at a lot of agencies,” Griffin said. “Ongoing monitoring is an important aspect of QAPI, but it requires both the right organizational structure and an effective means of data collection to be successful. Overall, home health and hospice agencies struggle with how to use data to implement evidence-based best practices.”

Effective QAPI programs integrate PI plans within the organization’s overall strategic objectives, Griffin said, and are supported by an organizational structure designed for efficiency.

“Beyond that, there’s no one-size-fits-all formula for QAPI success, as each agency’s program will be based on the unique areas where improvement is needed,” Griffin added. “Not surprisingly, agencies with a strong focus on leadership development and ongoing education for all staff tend to have an easier time with QAPI objectives.”

Outsourcing supports clinical and financial goals

Ongoing QAPI challenges have prompted a growing number of agencies to look at outsourcing their QAPI programs in the same way they outsource billing or coding services.

“Outsourcing has some strong advantages,” Griffin said. “When agencies outsource some or all QAPI program activities, they can reduce administrative costs and improve overall performance and outcomes.  It is a very attractive option for many agencies.”

Simione Healthcare Consultants responded to the growing demand for QAPI assistance earlier this year by expanding its long-time consulting in this area with the addition of Outsourced QAPI Solutions.

“As a provider of billing, collection, coding and OASIS review services, offering outsourced QAPI on an outsourced basis meets a critical need in an area where we have many resources to help,” Skehan said. “It’s one more step in our commitment to provide a comprehensive array of services for our clients.”

“Simione experts combine leading quality, regulatory and compliance expertise to help agencies sustain their quality programs. We’re working to help home health and hospice agencies hardwire a comprehensive, data-driven approach to maintaining and improving their organizational and quality and safety. From there, the foundation is set on which to build financial success and new opportunities for growth,” Skehan said.

Wondering how outsourcing works?

Here’s an overview of Simione’s Outsourced QAPI Solutions:

  • One-year contract priced competitively per provider number and based on average daily census per quarter (unduplicated)
  • Quarterly chart reviews using an automated tool for concise, aggregated results
  • Comprehensive quarterly summary reports (HH Compare, hospitalizations, incident reports/complaints, satisfaction surveys, infections, other routine monitoring as needs as identified)
  • Recommendations and guidance for performance improvement areas individualized to meet the agency’s QAPI program needs
  • Staff/manager training
  • Annual QAPI Reports (as required by state/accrediting bodies)

Additional QAPI Consulting Expertise

In addition to our Outsourced QAPI Solutions, Simione will continue to offer extensive industry and consulting expertise for organizations seeking comprehensive assessment of their current QAPI, emergency preparedness and compliance programs, and assist in program development to facilitate regulatory compliance and survey readiness, and support strategies to improve outcomes and meet quality reporting requirements. Our optional regulatory and compliance consulting support is tied directly into agency operations and other solutions as needed such as clinical service delivery, finance, and revenue cycle activities.

Call 800.949.0388 to discuss your QAPI program needs or get a free quote and visit

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