Overview

Nursing Home Quality CMS Should Improve Efforts to Monitor Implementation of the Quality Indicator Survey but does not routinely monitor the extent to which the objectives established for the QIS are being met. The first two studies, completed in 2006 and 2007, were commissioned to determine whether the new survey process could be used in real-world settings and whether the QIS was helping the agency meet several of the objectives established for the process. The studies' findings suggested that surveyors could use the survey process and recommended changes intended to help improve the QIS. CMS officials reported taking steps to address the studies' findings and recommendations. In 2009, CMS commissioned a third study that was completed in 2011 and identified aspects of the QIS process that could affect the consistency with which surveyors identify quality problems. For example, the study found that during resident interviews, surveyors did not consistently probe for further information when provided with incomplete responses to interview questions. However, CMS does not have the means to routinely monitor the extent to which the QIS is helping improve the survey process as intended. Such routine, ongoing monitoring would be consistent with federal internal control standards and could include the use of performance goals and measures. CMS does have access to some data, such as the amount of time surveyors have spent inspecting facilities, that could be used to help develop performance goals and measures.

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