fy 2020 idd quality review processes: quality enhancement

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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


• 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

https://www.nationalcoreindicators.org/

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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


• 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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QEPR Review

Tools

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QEPR Review Tools


• Support Coordination Record Review


• Administrative Review

• Staff Qualifications & Training (Staff Q&T)

The revised QEPR Tools are posted on

The Georgia Collaborative website:

www.georgiacollaborative.com

http://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


score



• Only in Choice FOA section





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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


score



• One for each service


score



• One for each service





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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





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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:




• Staff Q&T

Support Coordination QEPR

Report Content

Support Coordinator Overall Scores

Results and Recommendations:

• Support Coordinator Record 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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Contact Us

Thank YouThank You

fy 2020 idd quality review processes: quality enhancement

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