GAO Says CMS Should Improve Efforts to Monitor Implementation of the Quality Indicator Survey

CMS commissioned three studies to evaluate the Quality Indicator Survey (QIS-based survey) process but does not routinely monitor the extent to which the objectives established for the QIS are met. That according to the Government Accountability Office (GAO).

The first two studies, completed in 2006 and 2007 suggested that surveyors could use the survey process and recommended changes intended to help improve the QIS. In 2009, a study identified aspects of the QIS process that could affect the consistency with which surveyors identify quality problems.

For example, the study found that during resident interviews, surveyors did not consistently probe for further information when provided with incomplete responses to interview questions.

The GAO concluded that CMS has taken some steps to monitor and facilitate states' implementation of the QIS-based routine survey, but CMS's efforts are not systematic. States may not always participate in teleconferences, and those that do may not provide complete information on their progress. As a result, the information CMS obtains through its monitoring of states' progress may be incomplete.

CMS began implementation of the QIS-based routine survey process in 2005. CMS relies on the state survey agencies, as these agencies are largely responsible for the administration of nursing home inspections. CMS provides policies, guidance and some training for state surveyors.

Nine states were reviewed by the GAO. Recommendations include:

• Develop a means--such as performance goals and measures--to routinely monitor the extent to which CMS is making progress in meeting the objectives established for the QIS.
• Develop and implement a systematic methodology to track state survey agencies' progress with implementation activities.
• Develop and implement a systematic method for obtaining, compiling, and sharing information from state survey agencies about their implementation experiences.

CMS developed the QIS in order to improve nursing home inspections. After conducting demonstrations and evaluating the results of studies, CMS determined that the QIS should be implemented nationwide by 2018, using a phased implementation. To date, CMS has made progress implementing the QIS in 26 states.

According to the GAO, CMS lacks complete information on the extent to which states have met their implementation milestones, including the extent to which states are using the QIS tool once all surveyors in the state have completed training.

In a CMS response, they reported that the Department of Health and Human Services plans to institute an automated process to obtain updated information on states' progress with training surveyors which, when combined with existing data, could provide a more accurate assessment of implementation activities in any state.

HHS stated that CMS plans to expand existing information sharing opportunities--for example, quarterly calls and presentations at annual meetings--to be available to all states, not just those in the process of implementing the QIS.

CMS will focus efforts on more effectively implementing the QIS in those states where training of state surveyors has begun or has been completed, addressing barriers to QIS implementation, and completing the remaining components of the QIS.

I am not a quality guru. But I find it infinitely confusing to follow all of the quality organizations and quality standards that need to be followed. Then add on RAC and Red Flag and ICD-10 and I start to worry that all of these regulations and standards takes us away from common sense approaches to care and remembering who is at the center of that care.

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