​Q. Is the QIS rollout proceeding as scheduled?

A. The new contract year for Nursing Home Quality’s QIS training and implementation contract began on July 1, 2011, and QIS has already been initiated for all of the Band Two states, plus the District of Columbia. Thus, 22 states have undergone QIS training.  Of these, 11 states are fully implemented, which means all surveyors are trained and all surveys are now QIS surveys. Several more states are predominately QIS and will be fully implemented by the end of this year.

Six new states from Band Three are scheduled for QIS implementation between July 1, 2011, and June 30, 2012. Hawaii, Oklahoma, and Tennessee will be trained by the end of this year. Arkansas, New Jersey, and South Carolina will be trained in the first half of 2012.

Full implementation of QIS, however, requires more than the training of all state surveyors. The Centers for Medicare & Medicaid Services (CMS) has undertaken several other activities that will continue through this contract year. Most importantly, CMS began a concerted effort to train substantially more regional office surveyors to conduct QIS survey oversight activities in parallel with the expansion into new states.

Regional office surveyors have now been trained in every region, in numbers proportional to the number of QIS-trained state surveyors. One change from early QIS implementation is that all of these regional office surveyors are now trained in teams instead of being embedded in state agency trainings. Regional office training is an essential part of ensuring consistency across and within regions through both comparative and oversight surveys. 

As of November 2010 the upgraded federal QIS software was implemented following training of all QIS surveyors, which, among other changes, has streamlined QIS.

A top CMS priority is completion of QIS software for complaint surveys, revisit surveys, and extended surveys. Interim QIS procedures are in place for these types of surveys now but the software should result in greater consistency in these activities. The new software will also facilitate faster and more regular QIS updates as needed.

Although minimum data set (MDS) 3.0 is used for QIS sampling, QIS surveys continue to be successfully conducted without MDS 3.0 quality-of-care and quality-of-life indicators (QCLIs) or quality measures. As providers are aware, the other Stage 1 assessments, including the interviews, observations, and chart reviews, cover the majority of regulatory domains in a resident-centered manner. A subset of MDS 3.0 QCLIs is expected to be used during surveys in the next six months.

Andy Kramer, MD, is a long term care researcher and professor of medicine who was instrumental in the design and development of the Quality Indicator Survey (QIS).