In a new informational letter, CMS reviews the two recertification survey types used in the US, the Traditional Survey and the Quality Indicator Survey (QIS). The Agency describes how it has been evaluating the effectiveness of both survey processes over the past few years, and has found that both survey types have their merits.
The national rollout of the QIS was paused in 2012 due to operational challenges, the extended length of the survey and the need for additional changes. The findings from the QIS were compared against Traditional surveys in 2009, and did not find any major differences in the number of deficiencies cited or the scope/severity. The interpretive guidance provided to surveyors, the Critical Element Pathways and a lack of user-friendliness may have caused these similar results to occur. That led CMS to identify a set of changes to make to improve the QIS, with the latest set of updates to be rolled out in July 2015.
The July 2015 software updates will include:
- A revision to the size of the Stage 1 random sample to make it more proportional with facility census
- A modification to the Stage 2 sample selection process to allow surveyors more freedom of choice
- The ability to include a resident named in a complaint into the Stage 1 sample
- An update to revisit sampling to assist with updating the sample
- A reduction to medication administration sample size
- An adjustment to threshold triggers for Stage 2 care area concerns
- The shortening and revision of Critical Element Pathways
- The ability to incorporate complaint investigations into the QIS system
CMS is also trying to incorporate some of the pieces of the QIS process into the Traditional survey type to help with the future transition of states from one survey type to the other. Currently, the QIS takes about 20 hours more to conduct than the traditional survey, and surveyor training also takes much longer. Changes to the Traditional survey include that the medication administration observation sample size has been changed to match the QIS size. Critical Element Pathways investigative protocols will be implemented over time to help surveyors with investigative skills.
The Traditional survey type has its continued advantages for surveyors, such as being able to adjust the sample of residents reviewed, and the ability to change protocols more easily than the software updates required by the QIS. So for now, it looks like the rollout of the QIS is still on hold with the exception of the 26 states that are currently using it while CMS works on enhancing both survey types. The Agency notes that is it inefficient to have two survey types across the country, as it requires two types of training and staff that are knowledgeable on two different types of surveys for oversight, but does not provide a timeline for going to a QIS-only survey type.
Read CMS S&C “Information Only – Review and Status of Nursing Home Survey: Summary of Traditional and Quality Indicator Survey (QIS) Findings and Issues” (Ref: S&C 15-40-NH).
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