fy 2020 idd quality review processes: quality enhancement
TRANSCRIPT
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FY 2020 IDD Quality Review Processes:
Quality Enhancement Provider Reviews (QEPR)
Quality Technical Assistance Consultations (QTAC)
Presenters: Marion Olivier & Nancy Overs-Ikard, Georgia Collaborative
Virginia Sizemore, DBHDD
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Background and Philosophy for Changes
1. Increase reliability and validity of the tools and eliminate redundancy
between tools.
2. Focus on Provider Record Review as the primary source of information while
keeping the voice of the individual through participation in National Core
Indicators.
3. Removal of review activities to decrease administrative burden on providers.
4. Weighting of review sections will place emphasis on areas most important to
the Department.
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AgendaReview Activities
QEPR Sampling
QEPR Review Activities
Review Tools
QEPR Reports
QTAC
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Review
Activities
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New vs. Continued Review Activities & Tools
Continued New Deleted
Activity
QEPRs for Providers and
Support Coordination
Agencies
Person Centered
Reviews
QTACs
National Core Indicator
(NCI) In-Person Surveys
Tools
Provider Record Review Service Guidelines Tool Individual Interview,
Observation, Staff
Interview (IOSA)Individual Service Plan
Quality Assurance (ISPQA)
Checklist
Administrative Review
Tool
Staff Qualifications &
Training
Support Coordinator
Record Review Tool
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QEPR Review Activities
• Provider Record Review
• Service Guidelines
• Administrative Review and Staff Qualifications & Training
• NCI Adult In-Person Surveys
Provider QEPR
(193 annually)
• Support Coordinator Record Review
• Service Guidelines
• Administrative Review and Staff Qualifications & Training
• ISP QA Checklist
Support Coordination QEPR
(7 annually)
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National Core Indicator (NCI) Adult In-Person Survey
NCI
(480 Annually)
Randomly selected sample
based on the providers selected
each year
Conducted the week of the QEPR
ISP QA Checklist conducted for the
sample
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Quality Technical Assistance Consultation (QTAC)
• QEPR QTAC
• Individual and provider quality of care concerns
• Technical assistance and training requests
Quality Technical
Assistance Consultation
(QTAC)
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ChapterChapter
Sampling
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Sampling for QEPR and NCI
QEPR: ~193 Annually
• Select the provider sample
• Each provider will receive a QEPR approximately once every two years
NCI In-Person Survey (IPS): 480 Annually
• Randomly sampled from the individuals served by providers sampled for each year.
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Provider Size Caseload QEPR Sample Size
Small Caseload: 1 to 30 1 to 6 records
Medium Caseload: 31 to 101 6 to 15 records
Large Caseload: 101 and higher 16-30 records
Record review samples are selected based upon
3-6 months paid claims
Record Review Sample
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Staff Qualifications & Training Sample
Small Providers:
Maximum of 6 staff
Medium Providers:
Maximum of 10 staff
Large Providers:
Maximum of 16 staff
Review staff from all services provided, DDP, specialty services
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Quality Enhancement Provider Review (QEPR) Review Activities
Quality Enhancement Provider Review (QEPR) Review Activities
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Review Activities
Pre-Onsite
Onsite
Post Onsite
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Pre-Onsite Activities• QEPR Notification (2 week notice via email)
• Acknowledging the receipt of the QEPR notification via email is required within
two business days. Please include the following information in your response:
o Your address for the location of the review
o A contact name and telephone number
o What type of medical record you use (Paper, electronic, Electronic Medical
Record/Paper, etc.)
o The name and type of Electronic Medical Record (i.e., ShareNote, Carelogic,
etc.)
• If acknowledgement of the notification is not received within the required
timeframe and review cannot occur, the result may be an overall score of 0%
Pre-Onsite
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Pre-Onsite Activities
Expectations for Providers:
• Submit a list of employees who have direct contact with
the individuals served (excludes office or administrative
staff). Include the following in the employee list:
o Employee’s name
o Employee’s title
o Employee’s date of hire
o Services (i.e. CAG, CRA, CLS, etc.) provided by each
employee
• Assist in scheduling the NCI In-Person Surveys
Pre-Onsite
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Pre-Onsite Activities
National Core Indicator (NCI) Adult In-Person Surveys
• Individuals you support may be selected to be interviewed during the week of
the QEPR.
• The purpose of the interview is to gather data for the (NCI) Adult In-Person
Survey which provides insight about the services provided from the individual’s
perspective.
• NCI survey data are collected to compare statewide results and compare to
national norms. https://www.nationalcoreindicators.org
Note: Results are not included in the QEPR overall score. Pre-Onsite
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Onsite Activities
Onsite
Entrance Conference
• Overview of the process, finalize logistics, names of individuals selected for the record review provided and names of staff records selected
Administrative Review
• Review organization’s QI Plan, critical incidents, satisfaction surveys, etc.
Staff Qualifications & Training
• Review employee records including training, background screenings, and qualifications, etc.
Record Review
• Review up to 6 months of documentation
NCI In-Person Survey
• Conduct face to face individual interview
Exit Conference
• Provide preliminary findings and scores
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Post Onsite Activities
Post Onsite
Provider Notified
of Posted Report
Report Posted to
ASO Website
Finalize Report
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20202020
QEPR Review
Tools
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QEPR Review Tools
• Provider Record Review
• Support Coordination Record Review
• Service Guidelines
• Administrative Review
• Staff Qualifications & Training (Staff Q&T)
The revised QEPR Tools are posted on
The Georgia Collaborative website:
www.georgiacollaborative.com
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Record
Review
Provider Record Review Support Coordinator Record
Review
Focused Outcome Areas (FOA) Focused Outcome Areas (FOA)
• 6 FOAs
• Reasons Not Met
• Some indicators identified as a
quality of care concern
• 6 FOAs
• Reasons Not Met
• Some indicators scored only for
Intensive Support Coordination
Quality Indicators Quality Indicators
• Not included as part of the overall
score
• Scored as: Exceeds, Meets, Needs
Improvement, Unsatisfactory
• One for each FOA section
• Not included as part of the overall
score
• Scored as: Exceeds, Meets, Needs
Improvement, Unsatisfactory
• Only in Choice FOA section
The revised QEPR Tools are posted on
The Georgia Collaborative website:
www.georgiacollaborative.com
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Service Guidelines
Provider Support Coordination
Tool is scored for each service received Tool is scored once per review
Three service types: Two Service Types:
• Day Services
• Residential Services
• Specialized Services
• Support Coordination
• Intensive Support Coordination
Quality Indicators Quality Indicators
• Not included as part of the overall
score
• Scored as: Exceeds, Meets, Needs
Improvement, Unsatisfactory
• One for each service
• Not included as part of the overall
score
• Scored as: Exceeds, Meets, Needs
Improvement, Unsatisfactory
• One for each service
The revised QEPR Tools are posted on
The Georgia Collaborative website:
www.georgiacollaborative.com
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Administrative Review
Administrative Review tool
• Evaluates the organization’s systems and practices.
o Quality Improvement Plan
o Satisfaction Surveys
o DDP compliance
o Note: Not included in the overall score.
Staff Qualifications & Training tool (no changes)
• Evaluates employee records based on the standards.
o Qualifications
o Training
o Background Screening
The revised QEPR Tools are posted on
The Georgia Collaborative website:
www.georgiacollaborative.com
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QEPR ReportsQEPR Reports
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QEPR Report Changes
Report Changes
QEPR Final Assessment Report – posted on Collaborative website (no PHI)
QEPR Preliminary Exit Conference Report – given to provider (no PHI)
Provider QEPR
Report Content
Provider Overall Scores
Results and Recommendations:
• Provider Record Review
• Service Guidelines
• Administrative Review
• Staff Q&T
Support Coordination QEPR
Report Content
Support Coordinator Overall Scores
Results and Recommendations:
• Support Coordinator Record Review
• Service Guidelines
• Administrative Review
• Staff Q&T
• ISP QA Checklist
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Additional Exit Conference Reports
QEPR Provider/Support Coordinator Record Review Report
• Preliminary report that presents findings from each individual’s record reviewed.
QEPR Service Guidelines Report
• Preliminary report that presents findings from each individual’s record reviewed.
QEPR Staff Qualifications & Training Report
• Preliminary report that presents findings from each sraff record reviewed.
QEPR Administrative Review Report
• Preliminary report that presents specific findings from the indicators.
ISP QA Checklist Report
• Results for each individual from the NCI sample and Support Coordinator QEPR
• ISP QA Checklist Report uploaded to the Document section of CIS or IDD
Connects system
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QEPR Provider Score
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QEPR Scoring Methodology
Tool
Percent Met
(Total Scored
Met/Total Scored)
Weight of Score
(Percentage Points
out of 1)
Weighted
Score R
eco
rd R
evie
w
Whole Health 90.0% 0.15 13.5%
Safety 92.0% 0.20 18.4%
Person Centered Practices 89.7% 0.15 13.5%
Community Life 68.0% 0.12 8.2%
Choice 76.6% 0.10 7.7%
Rights 54.3% 0.12 6.5%
Staff Qualifications & Training 76.1% 0.10 7.6%
Service Guidelines 84.4% 0.06 5.1%
Overall Score 80.4%
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QTACs QTACs
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QTAC Types
QEPR:
90 days post exit
Quality of Care:
Individual or Provider level
Provider Request:
Specialized Topic
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Questions and Comments
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