Quality Initiatives for DOJ – QIC and QSR

September 23, 2020

QIC (Quality Improvement Committee) for DBHDS met this week to review and update the members on all of the activities proscribed as necessary to meet the requirements of the DOJ settlement.  Having been part of this committee for many years, I note that the structure, organization and output of the committee is vastly improved.  It continues to feel vastly “out-of-touch” with the reality of the community system of care, especially with the current priorities to respond to the pandemic and the significant fiscal concerns faced by providers, but the issues discussed are valid, if the methods of data collection are burdensome.

A chart showing a reduction in “falls” from 72/1000 (annualized quarterly data) to 65/1000 also noted the significant drop to <40/1000 in the most recent quarter.  There was discussion that since “falls” are most often reported in conjunction with an ER visit and ER visits, travel, many outside activities, and day programs all essentially stopped in that quarter due to the pandemic, the cause for the decrease is indeterminate.   The committee also approved new Performance Measures for compliance with risk management programs and quality improvement programs (12VAC35-105-520 A – E and 12VAC35-105-620); the standard set is 86% and data will begin to be collected in November when the revised standards will start to be reviewed.

The Mortality Review Committee has been looking at issues related to accessing 911 services as a prevention measure; the committee’s next focus will be deaths caused by sepsis.  There was note that as VDH is now providing most death certificates, the number of cases listed as death by unknown cause is much lower!

We continue to collect and share the multitude of issues with the QSR Reviews (see our recent post):

• We are trying to communicate with the DBHDS Staff overseeing the HSAG Contract to share the issues as they come up.
• Recent concerns continue to involve changes to the list of individuals to be reviewed for a variety of reasons and with little, if any, notice to the provider.  HSAG did say, in response to a question at the QIC meeting, that last minute changes which could not be complied with by the 31 October deadline, might require some extension of time for the provider to collect and upload the required documentation.  They certainly “understood the difficulty for the provider!”
• Another observation concerning the questions/requests which exceed current legal or regulatory requirements — some, such as interest in voting, are discussed in the PCP meeting and appear as a standard question on the annual Medicaid renewal form.  The discussion is not necessarily one that falls within the purview of the provider. 

Keep sharing both issues and concerns as well as estimates of staff hours required, including the staff time required to manage the virtual interviews, and participate in the interviews either themselves or in support of the individuals and families.