Transcript QIS Information to Support States Preparing for QIS Training and Implementation Agenda  Welcome and Introductions  Background and Overview of QIS  QIS – Continuous.

QIS
Information to Support States
Preparing for QIS
Training and Implementation
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Agenda
 Welcome and Introductions
 Background and Overview of QIS
 QIS – Continuous Quality Improvement
 State Roles and Responsibilities in
Training Process
 Description and Timing of QIS Training
 Questions
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What is the QIS?
 Approved Federal nursing home survey
process to increase consistency,
reliability and accuracy
 Uses customized software on tablet
PCs to guide surveyors through a twostaged systematic review of the
regulatory requirements
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QIS Development
 Produce prototype (1998 – 2005)
 Demonstration and Evaluation (2005 – 2007)
– Two teams each in: KS, OH, CA, CT, LA
 Develop and refine national training model (2006
2007)
– Three States: FL, CT, KS
 National implementation State-by-State to replace
Traditional survey (2007 – present)
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What Does the QIS Provide?
 Structured approach to achieve more
accurate and consistent results
 Larger and more diverse randomly
selected samples to obtain a more
accurate picture of the residents
 Automation to systematically review
regulatory areas, synthesize surveyor
findings, enhance investigative
protocols, and organize surveyor
documentation
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What QIS Is Not
QIS Does Not Represent:
 Change in Social Security Act
 Change in the Regulations
 Change in Interpretive Guidance
 Change in enforcement process
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Comparison of QIS and
Traditional Survey Process
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Automation
QIS
Traditional
Each team member
uses a tablet PC to
document findings
throughout the process;
findings are
synthesized, organized,
and loaded to the CMS2567 by the software
Information recorded on
paper throughout
process; computers are
used for Statement of
Deficiencies (CMS2567)
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Offsite Preparation
Traditional
 Review:
 OSCAR 3 and 4
Reports
 QM/QI Reports
 Results of
complaint
investigations
 Pre-select a sample
based on above
QIS
 Review:
 OSCAR 3 Report
 Uninvestigated
complaints
 Random selection of
Stage 1 samples from
MDS data loaded onto
tablet PCs
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Onsite Preparation
Traditional
QIS
 Roster/Sample Matrix –  Alphabetical resident
Form CMS-802
census with room
numbers/units
 List of new admissions
over last 30 days
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Initial Tour
Traditional
 Gather information
about pre-selected
residents and identify
new concerns
 Determine whether
pre-selected residents
are still appropriate
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QIS
 Brief overall
impression of the
facility, the residents,
and the staff
 Not intended for
sample selection or
supplementation
Sample Selection
Traditional
 Sample size determined
by facility census
 Residents selected
based on QM/QI
percentiles and issues
identified offsite and on
the initial tour
QIS
 Stage 1 sample size:
Admission (30)
Census (40)
 Stage 2 sample size
based on number of
triggered care areas
 Residents selected by
software
 Surveyor-initiated
sample
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Survey Structure
QIS
 Stage 1:
preliminary
investigation
 Stage 2: in-depth
investigation of
triggered concerns
from Stage 1
Traditional
 Phase I: focused
& comprehensive
reviews
 Phase II: focused
reviews
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Two Stages of QIS
Stage 1: Preliminary investigation of
regulatory areas to determine resident
care areas and facility practices for
Stage 2 investigation
Stage 2: In-depth investigation to
determine whether deficient practice
exists, document deficiencies, and
determine severity and scope
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Three Steps in Each Stage
1. Sampling (computer-generated)
2. Investigation
3. Synthesis
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QIS Stage 1
 Sampling – Random census (40) and
admission (30) samples
 Investigation – Structured resident, family,
and staff interviews; resident observations;
chart reviews
 Synthesis – 128 resident-centered and 34
facility-level Quality of Care and Quality of
Life Indicators (QCLIs) to identify care areas
that exceed national thresholds
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Stage 1 Triggers for Stage 2
Investigations
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Surveyor-Initiated Sample
Surveyors can initiate an investigation of
care areas for any resident or of facility
tasks. Because of the large QIS samples,
surveyor-initiated investigations are a
small part of the process.
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QIS Facility Tasks
 Completed on every survey
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–
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–
–
–
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Liability Notices & Beneficiary Appeal Rights Review
Dining Observations
Infection Control and Immunizations
Kitchen/Food Services
Medication Administration and Drug Storage
QAA
Resident Council President Interview
 Completed if triggered
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–
–
–
–
Abuse Prohibition Review
Admission, Transfer, and Discharge Review
Environmental Observations
Personal Funds Review
Sufficient Nursing Staff Review
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QIS Stage 2
 Sampling – Three residents per triggered
Care Area plus surveyor-initiated residents
(e.g., complaints)
 Investigation – Specific or general Critical
Element pathway or facility task pathway and
interpretive guidelines
 Synthesis – Determine compliance with each
Critical Element, document noncompliance at
the applicable F tags, determine severity and
scope
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Additional Information
QIS Satellite Broadcast:
http://surveyortraining.cms.hhs.gov/pubs/VideoInformati
on.aspx?cid=1082
QIS Resource Manual:
http://www.uchsc.edu/hcpr/qis_manual.php
QIS Electronic Forms and Worksheets:
http://www.uchsc.edu/hcpr/qis_forms.php
QIS Brochure:
http://www.cms.gov/SurveyCertificationGenInfo/downlo
ads/SCLetter08-21.pdf
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QIS – Quality Improvement
CMS-Federal Monitoring of the QIS
 RO surveyors trained in QIS process
 Desk Audit Reports
DAR-SA for State
DAR-RO for CMS Regional Office
 Federal Oversight of the QIS (FOQIS)
 QIS Comparative Survey
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QIS - Quality Improvement
Desk Audit Report (DAR)
a management tool which can be used by:
 The CMS CO for ongoing monitoring of
QIS consistency across Regions Offices
(RO) and States (SA);
 The RO’s for Federal Oversight of the QIS
process (FOQIS); and
 The SA’s for monitoring districts, teams
and individual surveyors
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RO & SA use of the DAR
 Reviews results;
 Raises questions;
 Investigates outcomes;
 Assists the RO & SA with
oversight/training; and
 Can direct SA monitoring
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Timeline
 CU sends 6 DAR-SAs with clinical analysis
and a call to discuss each
 CU sends 3 DAR-SAs with clinical analysis
and no call
 SA receives clinical analysis training
 CU and SA comparison for one DAR-SA
 SA assumes responsibility of analyzing
DAR-SAs
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Goal of QIS Data
Identify and address sources of
inconsistency:
Implementing the QIS process
accurately
Conducting adequate and thorough
investigations and making accurate
compliance decisions
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DAR-SA Review
1. Throughout each quarter, SA reviews
multiple DAR-SAs
– Identify and analyze outliers/trends
– Determine root cause
– Implement training, monitoring or
corrective action as appropriate
– Monitor effectiveness
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DAR-RO Review
2. At the end of the quarter, RO and SA
receives State-Specific DAR-RO
3. RO conducts QI call within 4 weeks (not
fully implemented)
4. Onsite FOQIS is conducted using a
targeted, data-driven approach (not fully
implemented)
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Preparing for Successful QIS Training
and Implementation
Review CMS Issued Documents
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Fiscal Year State Survey & Certification Budget Letter
(Mandatory Requirements - equipment and encryption)
State Operations Manual, Appendix P
QIS Training Process - State Operations Manual, Chapter 4
National Implementation Priority Order (S&C 09-50)
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QIS Satellite Broadcast:
http://surveyortraining.cms.hhs.gov/pubs/VideoInformation.aspx?cid=1
082

QIS Brochure:
http://www.cms.gov/SurveyCertificationGenInfo/downloads/SCLetter0
8-21.pdf
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Preparing for Successful QIS
Training and Implementation
 Informing State management about QIS
 Identifying QIS management and teams
 Educating stakeholders in the State
 Begin logistics preparation for initial QIS
classroom training
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Preparing State Management Team
for QIS
 Kick off call with State, CMS, and NHQ
 Orient and educate managers/supervisors about
QIS, the training process and
 State develops QIS training plan
 Identify a QIS State Lead
 Identify a QIS IT Lead
 Identify 8 surveyors to participate in initial/core QIS
Classroom Training
 Identify additional support staff to help with
preparatory logistics for QIS training
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Role of QIS State Lead
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Able to make supervisory decisions and provide oversight
Support the QIS process
Participate in QIS training, classroom and field
Achieve mastery of the QIS
Manage potential challenges from nursing homes
Serve as the point of contact for the State Agency for
discussion with CMS and/or its contractors
 Educate provider and consumer organizations
 Collaborate in the planning and preparatory activities with
the training contractor
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Role of QIS State IT Lead
 First line of contact for surveyors to address and resolve
software issues using the QIS process and QIS software
 Successfully completes ASPEN Technical Training
 Experienced and proficient with all ASPEN suite of products
 Creating survey shells in ACO
 Assisting staff with uploading surveys from ASE to ACO
 Participates in both classroom and onsite QIS training
 Able to train additional staff on the technical aspects of the
QIS process
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QIS Core Group of Surveyors
 State identifies eight surveyors (2 teams of
4) to participate in initial round (core) of
QIS training
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Minimum of two years of recent LTC survey experience
SMQT qualified
Possess intermediate computer skills
Prior teaching or training experience, if possible
 State selects four QIS trainer candidates from
initial core group of surveyors trained in QIS
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Educating Stakeholders on QIS &
State’s Implementation Plan
 Dedicate a section of State Web site for QIS
information and resources for stakeholders
 Schedule, announce and participate in “Overview
of QIS for Stakeholders” with CMS and NHQ
 Communicate with stakeholders regarding the QIS
process and the QIS implementation in the State
on an ongoing basis
 Stakeholder education is key to successfully
implementing QIS
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Preparatory Logistics and Tasks for
Core Group QIS Training
 QIS Classroom Logistics Checklist call with NHQ
 QIS IT Logistics Checklist call with NHQ
 Schedule 1-Day IT Training led by Alpine Technology Group
for State’s IT staff
 Secure all necessary equipment for QIS training
 Determine classroom location and nursing homes for mock
(simulated training)survey and surveys of record
 Load and test participant tablets PCs with QIS software/files
 State led computer orientation training for surveyors
participating in QIS training
*Please refer to the QIS Training Timeline document and QIS Classroom
Logistics Checklist for a detailed list of logistics
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QIS Classroom Training
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Training Requirements
for Registered QIS Surveyor
 Prerequisites
Proficiency with tablet PC functions and
computer skills
 Completion of classroom training
 Participation in mock training survey
 Participation in surveys of record with successful
compliance assessment
 Documentation in CMS Learning Management System
(LMS)
Initial (Core) QIS Training
Example
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QIS Train-the-Trainer (T3)
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Training Requirements for
CMS-Certified QIS Trainer
 Be Registered QIS Surveyor
 Successfully complete additional requirements
 Complete at least six QIS surveys of record
 Attend Train the Trainer workshop
 Provide the QIS classroom training
 Monitor surveyor-students in mock survey
 Conduct compliance assessment for surveyorstudents during a survey of record
 Remain actively involved in QIS training/surveys
 Documentation in CMS Learning Management System
(LMS)
QIS Train-the-Trainer (T3) Schedule
Example
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Tips for a Smooth QIS Training
 Provide a comfortable classroom learning environment and furnish
required equipment
 Educate State management about QIS
 Supervisors participate in training
 Recognize the learning curve and additional time needed to
complete QIS (Plan on a minimum of 40 in-facility hours per
surveyor per week)
 To the degree possible, select facilities for the mock & surveys of
record that do not have a history of serious care issues and
consider commute time for surveyors
 Avoid adding tasks such as licensure review to QIS surveys during
initial QIS training activities
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