Salary Survey: Prospective payment: A silver lining for quality managers?
Your talents, skills are more important than ever
The challenges posed by the transition to the prospective payment system (PPS) may hold a silver lining for quality managers: Never has your agency needed you more, to help turn reams of statistics into programs that serve patients and save money.
To take advantage of this opportunity, quality improvement (QI) staff need training to crunch OASIS data, look for trends, and help make critical decisions about care.
"OASIS gives them a new source of information that they never had before," says Patricia Spath, a consultant in health care quality and resource management with Brown-Spath & Associates in Forest Grove, OR. "They need to have better data management skills and analysis skills so they can interpret their OASIS data.
"Agencies are facing an overload of information, and they’re not quite sure what to do with it. Someone needs to have the skills to analyze that information and find opportunities for improvement," she explains.
Many agencies are entering the post-PPS world severely hampered by previous losses of quality improvement and education positions.
Lorraine Waters, BSN, MA, CHCE, director of Southern Home Care in Jeffersonville, IN, was among those who saw a quality management position fall to attrition during the round of downsizing that followed the interim payment system. Now Waters is appealing to have the position reinstated, certain that expertise will be essential to thrive under PPS.
"Some of the larger agencies are probably doing all right, if they retained some of those folks, but the medium-sized and smaller agencies I think are definitely under the gun to be able to monitor their own activities," she says.
As Waters sees it, the role of quality management will be to interpret what nurses are evaluating and to make sure the agency isn’t being shortchanged as far as revenue is concerned. She says that financial component is vital.
"I don’t think [saving money] was necessarily taken all that seriously in the past because things were a little bit more lax," she says. "We really weren’t seeing ourselves as a business, and that has definitely changed. We can’t operate as if we want to take care of the world, or we won’t be taking care of anybody."
Tools of the trade
Some of the tools a good QI director will bring to the role include continuing training, familiarity with up-and-coming aspects of quality management, and the ability to bring together a team to solve a problem.
Because so much of the quality information now being generated by agencies is database-driven, Spath says information management skills are a top priority.
While much of that training occurs on the job, she suggests that quality managers consider getting a master’s degree in health administration with a focus on information management. There also are information management master’s programs available.
Education level
In this year’s Homecare Quality Management salary survey, 45% of 22 respondents indicated that their highest degree was a BSN, the most common degree listed.
"I think they need to look at their own undergraduate training and ask themselves, What was I lacking?’" Spath says.
Waters agrees that such post-graduate education would be helpful but doubts many will seek it. For staff working in small or medium-size agencies, she says, salary restrictions won’t make an advanced degree cost-effective.
Of the 14 people who described themselves as directors of quality management or QM/PI coordinators in this year’s salary survey, half reported annual salaries of less than $50,000. The highest salary reported for either position was in the $70,000-$74,999 range.
Cathy Nielsen, RN, CPHQ, corporate compliance officer and vice president for clinical services at In Home Health Inc. in Minnetonka, MN, notes that the National Association for Health Care Quality can be an invaluable resource, offering educational programs and a certification process.
Keeping on top of the coming regulatory and accrediting changes that could affect your agency is a great way to stay irreplaceable.
The next big thing? Spath points to recent standards on patient safety improvement released by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) for hospitals. She predicts that a similar beefing-up of standards will happen down the road for home care agencies.
"They’re expanding the patient safety improvement steps, requiring that people be proactive in addition to just looking at sentinel events," she says. "It has implications for quality managers. They need to become more familiar with the proactive techniques for error-proofing processes."
Spath, who recently published Patient Safety Improvement Guidebook, which explores the topic, says JCAHO’s new hospital guidelines require that someone be named to lead patient safety improvement programs.
If similar standards were required of home health agencies, "that would be likely to be the quality person or perhaps the risk manager, but I would think in home health, those are probably very close to one and the same. They’d need to learn some new skills," she explains.
Nielsen says that among a quality manager’s most vital tools is the ability to manage people effectively. Keeping people motivated, tailoring your information to its intended audience, and helping agencies already whipsawed by change
to cope with even more can spell the difference in achieving success in the post-PPS environment.
"You need to do a lot of education, showing people the data, not finger-pointing, but saying, We’re having a problem here,’ and looking at how you can pull a team together to deal with the problem."
She emphasizes the importance of such skills as dealing with difficult people, trying to get people on your side, and seeking input from others.
More than a position
Nielsen says her company doesn’t designate one person as "quality manager" but instead expects the entire management team to demonstrate the skills that lead to continuous quality improvement. She doesn’t discount the usefulness of a quality manager in an agency that needs that type of direction, however. She advises managers to assess their own agencies, looking at what quality improvement skills they already have, and to fill in the gaps.
"You have to look at the core staff of the agency to see what their skill set is, see where their weaknesses are, what their strengths are, and how you can best serve that agency," she explains.
Spath worries that as more agencies are purchased by large companies, quality management could come to be seen as a corporate function, leaving branches without individual QI directors.
"What I see, if anything, is more coordination — one quality manager over four different home health agencies. There might be a data analyst or a data collector at the individual agency, but not somebody that’s a designated quality manager."
Waters is hopeful that the demands of PPS will make clear the need for the distinctive skills of a quality manager at individual agencies. "You’re still going to have to have someone doing the day-to-day overview and critically analyzing and evaluating," she says. "I’m hopeful that PPS will mean that we will see more positions.
"Nonrevenue-generating, yes, they may be, but in the long run, that is going to protect revenue, to have people really minding the store who know how to do it."
(Editor’s note: For more on the National Association for Health Care Quality, visit the organization’s Web site at www.nahq.org.)
Sources
• Cathy Nielsen, Corporate Compliance Officer/Vice President for Clinical Services, In Home Health Inc., 601 Carlson Parkway, Suite 500, Minnetonka, MN 55305. Phone: (612) 449-7654. Fax: (612) 449-7664. E-mail: [email protected].
• Patrice L. Spath, Brown-Spath & Associates, P.O. Box 721, Forest Grove, OR, 97116. Phone: (503) 357-9185. Fax: (503) 357-9267. E-mail: [email protected]. Web site: www.brownspath.com.
• Lorraine Waters, Director, Southern Home Care, 1806 E. 10th St. Jeffersonville, IN 47130. Phone: (812) 283-9190. Fax: (812) 283-2608. E-mail: [email protected].
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