Tuesday, December 30, 2014

Blame The QIDP

"The QIDP is responsible for everything."   You have likely heard that phrase spoken by administrators, owners, staff, surveyors, and you may have even spoken it yourself from time-to-time.  It is the quick out and the quick way to blame someone for all the problems.   In most cases, if you questioned the statement, you were quickly pointed to the federal standards and tag number W159, or as some know it, "The QIDP Tag!"  W159 is taken to mean that everything happening at the facility is the responsibility of the QIDP.  While each state is different in interpretations, and in some cases each surveyor is different in interpretations, most would agree that W159 focuses most of the blame squarely on the QIDP.  If we take the meaning at exactly the way it has been expressed then we can conclude that the QIDP is responsible for the following things:
1.  Billing
2.  What the physician does or does not do.
3.  What the nurse does or does not do.
4.  Data input to the state.
5.  Renewing the license for the facility.
6.  Setting up all the diets.
7.  Doing all the psychological
8.  Prescribing psychotropics as needed.
9.  Training staff on everything- OSHA, CPR, etc.
10. etc.

You may be looking at the list and thinking to yourself, "It's impossible for the QIDP to be responsible for all that stuff.  The QIDP doesn't even do our billing!"  You would be right in your assumption, it is impossible for the QIDP to be responsible for all that stuff.  In fact, there is a good chance that the use of W159 should not be the foundation to say the QIDP is responsible for everything, but instead it should be the foundation to say, "The QIDP should coordinate everything."  In other words, you can not be responsible for all those items listed above and you simply can not be "responsible for everything."  If that statement, used so often, that says, "The QIDP is responsible for everything," was true, then you'd have no need for most of the other federal tags.  Why would you need a dietician?  The QIDP can do it!  Why would you need someone in billing?  The QIDP can do it!  Why would you need an Administrator?  The QIDP can do it!  The fact is saying the QIDP is responsible for everything is simply wrong.  It's wrong to place this burden on a QIDP and it's wrong to express this saying.  However, QIDP's reading this, do not think you'll get off the hook that easily.

The fact is, as stated before, the correct expression should be, "The QIDP should coordinate everything".  A closer look at what W159 says will clearly show that the position of the QIDP is not to be responsible for everything, but instead it is to coordinate everything.  

W159 says "Each client's active treatment program must be integrated, coordinated, and monitored by a qualified intellectual disabilities professional."  That is the entire standard, and if you look closely you will notice the words "responsible for everything" can not be found.  In fact, the more appropriate wording that says the QIDP should ensure the program for each individual is "integrated, coordinated, and monitored" comes to light.  More simply put, the QIDP should "coordinate" everything related to the client's programming needs (and those can be many as you know!).  

As you know, W159 continues with questions and guidelines for the surveyor.  Without going into too much more detail, it is easy to read and see that the QIDP's function really centers on coordinating all the services for the people served, or the client.  That responsibility will require a lot of knowledge about what is going on with the person, what is happening around the person, and even the day-to-day basic functions of the home where the person lives.....it will not, however, mean that the QIDP is responsible for everything.  Should the QIDP have a working knowledge of everything that is going on?  Yes.  Should the QIDP be responsible to do everything?  No.  

The function of the QIDP is to coordinate and ensure that services meet the needs of the individual served or the client.  So, blaming the QIDP for everything based on W159 or any other assessment of the facility is simply wrong.   The QIDP should do his or her job and coordinate, but others in the facility program must do their jobs as well.  If you find you are in a facility where problems are constant, do not simply assume the QIDP is responsible.  Look at your administrative structure and deal with the appropriate person(s) for the problem.  Let's take a little time to stop blaming the QIDP for everything and start addressing the area of need.

Monday, December 8, 2014

Dealing With Negative Surveys

The fact is if you are a QIDP long enough, you're going to have a negative survey experience.  It's going to be based on one of three potential reasons that you face a negative experience in all likelihood.  Here are the three most likely reasons for a negative survey:

1.  Either you or someone within your organization fails to do the work required in an important area - an example might be the QIDP fails to type an annual staffing, the nurse does not do annual assessments, staff do not document data or goals, or the organization fails to get some required appointments or needs met per standards.

2.  A negative surveyor acting out of line - let's face it, nobody wants to say it, but the truth is some surveyors act differently than others.  While they should all hold the facility to the standards, there are simply some of them that have their own interpretations of what those standards mean.  In other words, they may "see something that's not in the standards," or "hold the facility to different level of the standards" (quotes I have heard from providers).  A surveyor that comes in with a negative attitude from the start can cause a difficult survey process to follow.  They tend to look deeper and longer, they tend to complain about everything, and often they make statements about right and wrong that simply are not part of the standards, but instead opinion based.   Surveyors will tell you that this doesn't happen; however, that would be to admit that surveyors are not human and subject to influences that can cause them to have a bad day.  Sorry, the fact is, some surveyors act negatively during the survey process.  Sorry - truth hurts.

3.  The final reason for a negative survey is usually a combination of the above two.  For example, you may have a really bad dietician who does not do his or her job.  As a result all the diets are wrong or there is a lack of training on some special diets needed.  Along comes a surveyor already in a "negative" mood and suddenly this issues is a major problem.  The surveyor becomes visibly upset and then starts to, as many people have stated, "dig for more bad stuff".  Often this process becomes extremely hard on the surveyor and the facility because it continues to grow.

So, with the above three potential situations in mind, what can the QIDP do to ensure a positive survey?  There are actually several things the QIDP can do:

1.  Try to ensure that all areas have been addressed prior to the annual survey.  Do a mock survey, find your weak spots (yes, you have them, we all do) and work on correcting them. 

2.  Make the survey process positive by being honest.  I'm not saying to go tell the surveyor something like, "Well, look over here on John's annual hearing test....we didn't get it finished for fourteen months instead within the twelve..."  No, there is no reason to hand the surveyor the deficient tag, let them look, but when they ask you about it, be honest.  This is your time to build a reputation and you want to have a reputation of being honest even in light of negative findings.  In other words, it's better to simply say, "I see what you're looking at and agree, we did not get the vision test completed in a timely manner.  We will correct that."  Don't lie - it's your reputation and the reputation of the facility that you need to maintain.

3.  If a surveyor becomes aggressive when seeking answers or is being negative, try to remain positive.  We have all seen surveyors that appear to attempt to make everything that has gone wrong a terrible thing!  I have heard QIDPs, staff, managers and even owners say things like, "Wow, we know it's a mistake and we need to correct it, but that surveyor is just hounding us over it," or "If that surveyor acts like that, I'm not coming back in the morning."  Simply remain as positive as you can and answer the questions directly.  I once had a negative acting surveyor asking me direct questions that to be honest I did not agree with the findings that were being presented.  I could tell the surveyor was going to "jump" on anything I said in a negative manner based on the fact that they just had over two things I already answered.  I simply changed my form of answers to "Yes" or "No".  When the surveyor prompted me further on a question I had answered "No" to by saying, "So are you telling me that you did not do this?"  I responded, "Yes, I am telling you we did not address that."  Naturally, the 2567 had a statement that said, "QIDP A stated that he agreed and the facility did not address X".  

4.  Get the deficiencies, write the POC and address them.  Simple.

5.  If you truly feel that the survey was negative and it was not yours or the facilities fault, first complete the comment option (online in Texas), consider talking with the surveyor's supervisor, and finally if needed file a formal complaint following your state's guidelines.  However, remember that you may have to deal with the same surveyor again, the surveyor may have just had a bad day, or maybe....just maybe, you did have a negative survey because of issues within your facility or you were having a bad day....

Ultimately, regardless of the outcome of any survey, you need to remember that surveyors are not there to "Pat you on the back" and tell you what a great job you and your staff are doing.  They are there to ensure compliance with a minimal set of standards.  They look for the negative things in the facility and that is their job.  While they may like things you are doing that are positive, there is always a good chance they can find something wrong.  They are human and just like you they can make mistakes or misunderstand something you have been working on for the facility.    Just because one set of surveyors finds something wrong, it does not mean the next set will find the same issues.  It's just part of the nature of the business.  The bottom line though is that a survey process, the corrective action taken after the process, and the continued work between surveyors and facilities should have an end result of one thing:  Improving the lives of people with Developmental Disabilities, and if that can happen in the end, that's all that really matters.  

Sunday, December 7, 2014

QIDP, QDDP, ICF - What Does It All Mean?

One of the major questions that I am asked all the time is "What do you do?"  When I respond, "I'm a QIDP," you can imagine the blank stares I get.  People look at me with the old "Deer in the headlight" look as they ponder their next question.  The next question comes quickly, "What's a Q...?"  They naturally trail off because they did not hear exactly what I said or they did not understand.

At this point in the conversation, I usually respond, "I am a consultant for homes serving people with disabilities.  I write programs and goals for the individuals living in those homes."  Guess what?  I'm suddenly classified as a "Computer Programer" and everyone is excited because they think I'll be able to write them a neat little app for their cell phones.  While writing apps, and other work is a nice attachment hobby, it is not what a "Q" does or even what it means to be a "Q".

For those aware of the terminology, the next part is going to be a little boring.  The old term "QMRP" stood for Qualified Mental Retardation Professional.  The term basically means that the person is "qualified" to write goals and to serve in a certain capacity to help people who have a diagnosis of Mental Retardation.  There are specific federal standards, and in some cases state standards, around the country that address what a Q does and his or her role (http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_j_intermcare.pdf).

With the changes of terminology brought about by Rosa's Law (http://myqidp.com/Rosa%27s%20Law%20and%20changes.pdf) the use of the term "Mental Retardation" was removed from use in the United States.  Naturally, when that change was made, the acronym "QMRP" was no longer appropriate.  Some states elected to change the term to "QDDP" or Qualified Developmental Disabilities Professional, while others went with the federal change to "QIDP" or Qualified Intellectual Disabilities Professional.

For lack of a better way to explain the position a QIDP or QDDP is simply a person who works and writes goals and data to help individuals with Intellectual Disabilities learn to live more independently.  The Q may be found on a state level working for organizations such as large or small institutions, or on a smaller level working for ICF (Intermediate Care Facilities) in settings with six to twelve people being served.  Ultimately, the Q is essentially a "Case Manager" and has duties much like those of any human service case manager.  While there are many different views of how a QIDP should work, there is a national organization that bonds these Q's together and even provides formal training (http://www.qddp.org/).  Other organizations offer training and consulting services such as my own organization (http://myqidp.com).

QMRP = Qualified Mental Retardation Professional (outdated now)
QDDP = Qualified Developmental Disabilities Professional
QIDP = Qualified Intellectual Disabilities Professional

ICF/MR = Intermediate Care Facility for people with Mental Retardation (outdated now)
ICF/IID = Intermediate Care Facility for Individuals with Intellectual Disabilities

Within the world of ICF settings, there are several other acronyms you may encounter.  Some can be found on my site at: http://myqidp.com/ICFMR.htm