Why QAPI spells success for skilled nursing facilities

Category: QAPI, skilled nursing facilities, SNF, CMS

Why QAPI spells success for skilled nursing facilities


The skilled nursing sector has seen a significant number of facility divestitures and closures in the last few years.

Quite frankly, this trend is due in part to a reluctance by some to implement clinical-based care standards and a lack of honest self-evaluation to improve the clinical care provided at skilled nursing facilities. Outdated operating models – solely meeting the basic needs of patients – do not bode well for SNF operators to survive.

The colonial mantra “join or die” can be applied to operators who do not implement robust clinical care standards. Operators who “join” will improve the types and quality of care provided to patients by incorporating Quality Assurance and Performance Improvement (QAPI) standards, advancing patients’ clinical care and outcomes, and shifting from considering patients a “resident” to, yes, a patient.


Many operators have been reluctant to really adopt QAPI standards due to the notion of it being just another government “we know better than you” program and uncertainty about the permanence of guidelines and standards developed as part of the Affordable Care Act.  However, the shift from strictly fee-based to value-based care is progressing, and it is here to stay.

Today’s successful SNF will be compelled to not just identify, but demonstrate, itself as a healthcare provider; it must walk the walk. Many facilities, however, are still operating under a model of “warehousing the elderly” – caring for an individual’s basic needs but not comprehensively addressing all the patient’s post-acute healthcare conditions.

QAPI standards provide a roadmap for SNFs to systematically change and focus their operations as a healthcare provider, and adoption of these program guidelines will lead to improved quality outcomes which will ultimately make or break the business.

QAPI guidelines promote value-based care and clinical outcomes – and reimbursement tied to the level of care – will be the standard for the “Quality Payment Program.”

Many operators have carried on with business as usual without adopting QAPI standards and, not so surprising, some have received disastrous results on state and federal surveys.


QAPI, simply, is – 1) QA (quality assurance) – specific standards of care and outcomes and a process throughout the organization for assuring adherence to those standards and 2) PI (performance improvement) which is more forward–looking and is the continuous study of possible improvements and new approaches. In other words, “PI can make good quality even better.”

The five elements of QAPI provide a guide for operators to avoid substandard care and prevent poor outcomes:

  • Design and Scope – A program must include all areas of operation and all facility staff members.
  • Governance and Leadership – Facility leadership must ensure QAPI extends to all stakeholders (patients, families, and staff) and maintain open communication for improvement in all areas.
  • Feedback, Data Systems and Monitoring – Facilities must collect data to ensure performance standards are being met and stakeholder feedback is being used effectively.
  • Performance Improvement Projects – Operators must work with staff to address particular problems and take steps to improve them.
  • Systematic Analysis and Systemic Action – SNFs must set ways to identify and analyze how issues have been caused and put in place systems of continual learning and continuous improvement.


Maximizing the implementation of a QAPI program will permit facilities to excel on state and federal surveys, earn higher ratings, and enhance their reputations and referrals. Embracing the QAPI model offers SNF operators the infrastructure they need to adapt to the changing healthcare landscape.

Despite political and policy uncertainties for the healthcare sector, SNF operators must be open to change.

QAPI is an effective model for operational success. Following QAPI guidelines should lead to more positive patient outcomes and continued, and perhaps increased, Medicare and Medicaid reimbursement to come. 

CMS has stated that “QAPI amounts to much more than a provision in Federal statute; it represents an ongoing, organized method of doing business to achieve optimum results ...”

There is an abundance of information and a number of resources available on CMS’s website to explain and assist in the implementation of a QAPI program, for example, QAPI at a Glanceand QAPI Written Plan How–To Guide.

Heck, sometimes the government gets it right.

Top of Page