The New Quality Indicator Survey: What it means for you
By Paula Bracken, MHA, Clinical Consultant

As nursing home administrators and directors of nursing, you may have already heard that there is a new Quality Indicator Survey (QIS) coming down the pike. Some of you may have attended a seminar or read something in a professional journal about the new process and may be wondering what this means for you as a provider and how you will prepare for such a new change in survey. As a former surveyor who knows the traditional survey process very well and who has received intensive training on the new Quality Indicator Survey under the direction of Andrew Kramer, MD, creator of QIS, I can assure you that this new process is a big improvement. There are four main objectives of the QIS:

1. Improved consistency in the survey process
2. Comprehensive review of all F tags during the survey process
3. Enhanced documentation through the use of automation
4. Focus of survey resources on facilities with the greatest quality concerns

Background

Shortly after the implementation of the traditional survey process in 1992, Dr. Andrew Kramer was asked by Congress to evaluate the traditional survey process and determine if it was outcome-based. His research showed that the traditional process was not outcome-based and he was then hired by CMS to develop a new survey process. A two-stage survey process was developed between 1992 and 1997. Between 1997 and 2005 the new process was further developed and refined with assistance from University of Colorado, University of Wisconsin, Maverick Systems, and Alpine Systems. In 2005, a demonstration project was initiated by CMS to evaluate QIS in six states, Connecticut, Kansas, Florida, Louisiana, Ohio and California. The demonstration was successful and a national rollout of QIS began in 2007 with statewide expansion beginning in Florida and four other states. The Centers for Medicare and Medicaid Services (CMS) will select states for implementation or individual states may apply for QIS implementation over the next four years.

Overview

The QIS is a two-staged process, with Stage I being a preliminary review of several care areas and Stage II being an in-depth review of triggered care areas based on data gathered from Stage I and MDS data analysis. Stage I involves resident, family and staff interviews as well as brief record reviews that help focus areas for review in Stage II.

There are also facility-level reviews that every facility receives and additional facility reviews that must be triggered in order to be reviewed in Stage II. The QIS has 51 care areas and 162 quality of care and life indicators that can be potentially reviewed. Every care area is linked to specific F-tags that identify potential deficiencies in the facility.

The Difference

QIS is a process that evolved out of much research and involves the use of automation and algorithms to focus the survey process. QIS is different because it gathers significant consumer data from residents and families. Forty-nine percent (49%) of data gathered from Stage I is based on resident and family data, making it more consumer-driven and focused. QIS also uses three samples, a census sample of 40 residents, an admission sample of 30 residents and an MDS sample. The census and admission samples are used in Stage I and the MDS sample is used in Stage II. While the QIS uses MDS data to assist in the identification of Care Areas for in-depth review, it accounts for only 24% of the Stage II review process.

The new QIS lends itself to quality assurance and quality improvement. The QIS is designed to help providers become proactive with their quality assurance and improvement efforts on a continuous basis instead of waiting to assess their compliance before the annual survey. Many facilities have successfully learned to use the QIS tools on an ongoing basis to focus their quality assurance efforts. It is essential that facilities receive accurate and thorough training in using the QIS tools to effectively use them for quality assurance.

Survey Deficiencies

There are some regulations (F-tags) that are cited at higher rates under QIS than the traditional survey. Some examples include Quality of Life, Resident Assessment, Resident Rights and Dental Services tags. Because of automation and design, the QIS is able to comprehensively review all F-tags for compliance, which means that those F-tags typically not reviewed as thoroughly under the traditional survey will be looked at more closely because of the new process.

In Summary

To sum up, QIS brings much change to the long term care survey process. It is important to understand that the QIS creators had providers in mind when developing the new process. In fact, the same tools that are used by the surveyors are available at no cost to providers. The tools that are available can help providers assess both quality of care and quality of life for their residents. Providers should begin to prepare now to learn QIS and how to use the tools as a quality assurance measure on a continuous basis. The essential skills needed to successfully prepare for a QIS survey or use the QIS tools for quality assurance can be acquired by receiving the proper training by an accredited instructor.