What else is in QM?

[Enarra, BSN, RN]

I realized that quality management ( QM) work has large variability in its title and function.   I

  I'm a improvement specialist - work on PI projects, peer review committees, Root cause analysis, pdsa cycle.  

what other positions are In quality management and can you share your experience and job role?  

[NRSKarenRN, BSN, RN]

Risk Management activities may include

• Responsible for the overall patient safety and clinical risk management functions related to review and response to reported events.
• Responds to crisis situations that have patient safety and risk management implications and assists staff with problem solving.   
• Review facility policies + updates to ensure compliance with current national regulatory standards. Provides compliance education and policy development.
• Performs audits and inspects patient care areas and works collaboratively with the health care team to ensure compliance with regulatory and accrediting bodies
• Ensure enforcement of privacy policies and HIPAA compliance 
• Monitor compliance with the privacy program and investigate incidents 
• Coordinate privacy matters related to information systems with Director of Information Systems.
• Works with Legal Department to perform chart review of pending legal cases to ensure all clinical information provided for case review.

Quality management in home care can include:

• Assigning ICD10 codes post review clinical documentation of Medicare OASIS assessment and care plan, reviewing care plan to confirm meets Medicare/Medicaid/Insurance guidelines.
• Assures agency staff complies with federal/state and accreditation regulations through record review, case conferencing, mentoring and survey readiness/oversight functions.
• Contacting/hounding Physicians/NP/PA to get the home health Plan of care signed within regulatory time frame.

Additional HH Quality management job description includes

Quote

• Supports in-service education and other continuing education activities related to quality, outcomes, QA/PI.  Monitors publicly reported outcomes and other data, utilizing quality software and EMR reports.
• Review discharge, death at home and other OASIS documentation for accuracy, completeness, and recommends corrections, utilizing appropriate software and OASIS guidance.

Lots of variation in this role between inpatient/ home care/ SNF outpatient settings dependent  on facility needs. 

 

While I was a Home Health Central Intake Manager,  performed risk management activities  above and participated in health system risk management committee.  Quality Management in that role included identifiying primary medical diagnosis reason for home care admission and initial ICD10 code for staff to obtain authorization for homecare. This included having documentation from referral source/physician to support diagnosis, tracking down missing items.  Educated staff in above items.  

Implemented 2 electronic medical record systems.  Learned from the mistakes of first EMR started 9/2002  (first day as manager, not part of build) that DOS data entry was never cleaned up for duplicates, physician list accurate or updated, initial entry for data to flow to billing department --all the boxes checked off for activity to occur took 3 years to figure out issues.  

Responsible for checking Medicare/Medicaid/Insurance company updates to meet regulatory requirements. Assigned MY responsibility to set up electronic insurance company access (business Mgr  "not computer savy") + agency passwords along with price negotiating services for non-contracted payers.  3yrs after leaving position for HH Utilization review/coder position, business staff still asking for Insurance spreedsheet setup which had listed this info+ had sent to department 3x.   

Was fun when National Provider Identifier (NPI) number started, later Medicare requiring every 5 years reverification of Medicare # enrollment --with 10,000 provider database.  Had to manually search each provider in NPI  along with Medicare website to obtain # or contact provider that they needed to obtain one. And yes, you need to contact Medicare to reverify your MC # as it's listed as inactive and agency (along with PROVIDER) can't bill for services. All needed to be able to bill for services.   Hired HR directors college son and his 2 friends to work on weekends to obtain info and data entry.   Year later, companies setup websites where one could upload facility database to obtain/verify NPI/MC numbers. Add in verifying active license + any sanction checks monthly.  HOW to do this was my job to figure out,  part of "maintaining regulatory standards" thing.

🙂