In a new report, the General Accountability Office (GAO) advised the Centers for Medicare & Medicaid Services (CMS) to improve the way it monitors implementation of the Quality Indication Survey (QIS) process for nursing homes.
The QIS is a revised long term care survey process that was developed under CMS oversight. It represents an effort to standardize how the survey process measures nursing home compliance with federal standards and the interpretive guidelines that define those standards.
The new review, GAO-12-214, follows earlier studies of the QIS-based survey process and builds on suggestions for changes that CMS has agreed need to be made.
“In 2009, CMS commissioned a third study that was completed in 2011 and identified aspects of the QIS process that could affect the consistency with which surveyors identify quality problems,” GAO said.
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.
“However, CMS does not have the means to routinely monitor the extent to which the QIS is helping improve the survey process as intended. Such routine, ongoing monitoring would be consistent with federal internal control standards and could include the use of performance goals and measures,” GAO said.
GAO said that CMS officials reported taking steps to address the study’s findings and recommendations and noted the agency does have access to some data, such as the amount of time surveyors have spent inspecting facilities, which could be used to help develop performance goals and measures.
“CMS has taken some steps to monitor and facilitate states’ implementation of the QIS-based routine survey, but CMS’ efforts are not systematic,” GAO said.
As part of the CMS effort to monitor states’ implementation, it primarily uses quarterly teleconferences with state survey agency officials to obtain information on the extent to which each state has completed training all its surveyors to use the QIS. However, states may not always participate in the 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,” GAO said.
To help facilitate states’ implementation of the QIS, CMS provides states with guidance, gives presentations, and offers states opportunities to share their implementation experiences through quarterly teleconferences.
However, CMS does not have a systematic method for obtaining, compiling, and sharing information on state experiences, especially information on approaches states have taken to help facilitate implementation of the QIS. Systematically sharing such information—for example, through CMS’ annual conference in which all state survey agencies participate—could help the agency facilitate implementation in states that have not begun QIS implementation, GAO said.
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