Nursing homes that receive federal Medicaid or Medicare funding must meet federal quality standards. The Centers for Medicare and Medicaid Services (CMS) and states, accountable for ensuring compliance, inspect nursing facilities periodically using a CMS-developed and state-administered survey or inspection process. The Quality Indicator Study (QIS) is a new electronic study slated for implementation nationwide by 2018 to improve survey accuracy, efficiency, and consistency.

GAO conducted a study on the extent to which CMS:

  • Evaluates progress in meeting its QIS objectives.
  • Monitors and facilitates states’ QIS implementation.

Results were released in a new report to Congress, Nursing Home Quality: CMS Should Improve Efforts to Monitor Implementation of the Quality Indicator Survey.

According to GAO findings, CMS commissioned three studies to assess the QIS-based survey process. Those studies were completed in 2006, 2007, and 2009. While CMS did not routinely monitor how well established objectives were being met, the study did note that it did not have the means to do so as CMS lacks access to certain data needed to monitor performance goals and measures on an ongoing basis consistent with federal internal standards.

Quarterly teleconferences are one of several steps CMS has taken to monitor and facilitate states’ implementation of the QIS-based survey. During these calls, states receive guidance and presentations on implementation. Nevertheless, not every state survey agency official has participated, and the data acquired has, at times, been incomplete. While participants are encouraged to share implementation experiences, CMS lacks a systematic method for gathering and sharing information about those successful approaches. CMS plans to develop a more systematic process, but they have not yet established a timeline.

In the report, GAO made two primary recommendations, both of which CMS concurred:

  1. CMS should devise a means to track progress in meeting QIS objectives.
  2. CMS should develop a systematic process for monitoring and facilitating implementation of QIS.

To read or download the full brief, click here (PDF).