Report argues CMS must monitor progress of Quality Indicator Survey

The Centers for Medicare & Medicaid Services should develop performance goals and measures to monitor the ongoing progress of the Quality Indicator Survey (QIS), a new report recommends.

The Government Accountability Office report, commissioned by Sens. Herb Kohl (D-Wisc.) and Chuck Grassley (R-Iowa), says the QIS was intended to improve the nursing home survey process, but CMS is not routinely monitoring the extent to which objectives are being met.

The QIS, which has been implemented in 26 states as of September 2011, is an electronic survey process whereby surveyors record their findings on tablet computers. Software then organizes the survey findings.

QIS software also selects a random sample of residents to identify areas of concern at the start of the survey, which differs from the traditional survey.

CMS began moving toward the QIS process in 2005, but the agency has temporarily suspended implementation due to concerns raised by states and regional CMS offices.

“If CMS were better tracking state implementation from the beginning, the agency could have identified these problems earlier and helped the states that are struggling,” Grassley said in a statement.

In the report, GAO wrote that CMS periodically monitor states’ progress on QIS milestones and that it plans to develop a more systematic process for monitoring states’ progress toward completion of state surveyor training and use of the QIS-based process for routine surveys. “However, officials said the agency has not yet established a time line for the development of this method,” the report read.

“There’s an obvious need for a clear, consistent and efficient system for monitoring nursing home quality,” Kohl said. “QIS has the right goals in mind, and has the potential to make a positive difference in the consistency and accuracy of state survey work across the country—but implementation needs to be done well, and the agency’s goals need to be realized sooner rather than later.”

The Department of Health and Human Services concurred with all of the GAO report’s recommendations.

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