GAO Issues Study on Implementation of the Quality Indicator Survey (QIS)

This week the US Government Accountability Office (GAO) issued a study: Nursing Home Quality: CMS Should Improve Efforts to Monitor Implementation of the Quality Indicator Survey.  The study asserts that the Centers for Medicare & Medicaid Services (CMS) has not done an adequate job of monitoring the implementation of the QIS.   While CMS has taken some steps to monitor implementation progress of the QIS, the monitoring has not been systematic nor is it consistent with federal internal control standards.  (Virginia’s State Survey Agency (OLC) has not yet implemented the QIS survey process and has not indicated at what point Virginia will implement the QIS.)

Of particular interest in the report is the GAO position that “In the case of the QIS-based routine survey process, information collected through performance goals and measures could help CMS routinely monitor the extent to which the objectives of the QIS are being achieved.  This information could also inform future efforts by CMS to modify and improve the QIS process as needed.”  CMS agreed with the need for certain performance measures, particularly with regard to examining the effect of the QIS on surveyor consistency.

GAO Recommends that CMS

  • 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; and
  • Develop and implement a systematic method for obtaining, compiling, and sharing information from state survey agencies about their implementation experiences.
CMS Responses to the GAO Recommendations

CMS concurred with these recommendations and intends to:
  • Establish new or modify existing measures or processes to more effectively monitor CMS’s progress towards meeting QIS goals and objectives.  CMS is already reviewing available data related to the QIS (for example, data on survey workload, survey deficiencies, and the number of surveys performed) to more effectively monitor the QIS and guide improvement efforts.
  • Formalize the data collection method used to track states’ progress with QIS implementation activities.  CMS will 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.
  • Enhance existing and add new methods of sharing information on the QIS with states.  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 is also considering using a web-based capability to facilitate sharing information on QIS implementation.