Transcript Quality Indicator Survey (QIS)

Quality Indicator Survey (QIS)
ELIZABETH HONIOTES
CENTERS FOR MEDICARE & MEDICAID
SERVICES
QIS - Overview
 Revised Long Term Care survey process
 Two survey stages of review
 Tablet PC and database design
QIS - Objectives
 Improve consistency and accuracy of the survey
 Comprehensively review more regulatory areas
within current survey resources
 Enhance documentation through automation
 Focus survey resources on facilities with the greatest
quality concerns
QIS – First Stage
 Preliminary investigations conducted
 Structured resident, family & staff interviews
 Resident observations
 Record reviews
 Analysis of Minimum Data Set (MDS) data
QIS – First Stage
Preliminary investigations
Quality of Care & Quality of Life Indicators (CQIs)
CQIs are compared to national norms
Identify Care Areas for Second Stage
QIS – Second Stage
 In-depth quality investigations
 Critical Element Pathways for investigations
 Assessment
 Care planning
 Reassessment
 Care areas are mapped to specific F tags
(regulations)
QIS Software
 Previously using Research Grade Software
 Can be cumbersome for surveyors
 Currently using Production Software
 More stable than research grade
 More convenient for surveyors
 Automatically encrypts data
 Easier to navigate
 Easier data sharing among the survey team
QIS – Time spent on survey
Based on Ohio Experience (2009)
 Average time on survey – 192.61 hours
 Greater than traditional survey – 118.29 hours
 May decrease as teams become more experienced
QIS – surveyors
Average number of surveyors/survey (Ohio-2009)
 QIS – 4.7 surveyors
 Traditional – 3.4 surveyors
QIS - Citations
Average number of citations/survey
Based on Ohio Experience (2009)
 QIS – 7.74 tags
 Traditional – 5.7 tags
QIS – Scope/Severity
Ohio Experience (2009)
 Most citations represent D level deficiencies for the
QIS and traditional surveys (62%)
 Second highest citation rates are at E level
deficiencies for both types of survey (19%)
QIS – Demonstration Phase
 Phase 1 –9/05 Connecticut, Kansas, Ohio
 Phase 2 – 2/06 – California, Louisiana
 Phase 3 – 10/06 – Florida tested a statewide
implementation to prep for national rollout
 National implementation progressing state by state.
RO V QIS Implementation
Full implementation of QIS throughout
the State
310 surveys in 64 counties conducted
60 facilities/27 counties repeat QIS
Full implementation by December 2011
QIS – National Implementation
 Indiana -Band Two of state groupings
 implementation to be initiated January 2011
 Wisconsin -Band Four
 Illinois - Band Five
 Michigan-Band Six
 Implementation in all 50 states depends on
the annual budget allocations for survey and
certification.
Federal Monitoring Surveys for QIS
 Federal Oversight Quality Indicator Survey (FOQIS)
 FOSS-light process
 More focused than traditional Federal Oversight and Support
Survey (FOSS)
 Data sharing between state team and federal team
Federal Monitoring Surveys for QIS
RO V FOQIS Experience
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Encryption software incompatibility
Research-grade software version of FOQIS used in 2009
 Revised FOQIS process is under development

•
Current approach to meeting our 5% oversight obligation for
observational surveys (FOSS)
RO embed with State teams (RO part of the survey team)
 Observe non-QIS surveys (when available)
 Observe complaints and revisits

Federal Monitoring Surveys for QIS
 Comparative FMS
 QIS comparative protocol under development
 Modified comparative for look-behind of QIS
Hybrid Traditional/QIS survey
 Use QIS information from State survey
 Compare outcome similar to traditional look-behind
 Consider the focus of the State team when comparing survey
findings (i.e., would not hold State accountable for tags that
involved care areas they did not investigate).

Federal Oversight
 Revisits and Complaint Investigations
 Currently no QIS process
 Continue with current traditional process for oversight (FOSS)
QIS-Tools for CQI & Oversight
Tools for State supervisors & managers
(currently under development)
 Reports on survey data among specific survey teams
and surveyors
 States can explore and address variations among
surveys and teams (not available in traditional
surveys)
QIS-Tools for CQI & Oversight
Tools for CMS
(currently under development)
 Output reports and feedback systems
 Review each state to determine statewide variations
 Address and reduce variations between states
QIS – Future Research
 To examine key aspects of QIS
 Focus on the extent to which QIS will provide better
tools for continuous quality improvement
QIS – Private Sector
Quality Assurance Tool for Providers (to be developed)
 Nursing homes may use QIS for self-analysis
 CMS plans to make info publicly available for broad
use in nursing homes
 Private sector use of the QIS methodologies will need
to be privately funded by nursing homes
 No date set, yet – far into the future
QIS
[email protected]
Questions?