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QIS Rollout Provides Insight For Preparation

Dr. Andy Kramer
Provider Magazine – August 2010


What is the status of the QIS rollout,
and how can I prepare?


The Centers for Medicare & Medicaid Services (CMS) has published a Survey and Certification Letter that describes the agency’s intended implementation priorities with regard to states. Implementation will take place in states according to a priority order in groups called “bands.” There are six bands in total, containing all of the remaining states and territories yet to undergo QIS implementation.

Each band will be implemented during a one-year period starting in July and ending in June the following year. The order of implementation within each band is determined as each year approaches and depends on the states’ ability to prepare for it and the scheduling of resources with the QIS training contractor. The CMS letter (S&C 09-50) can be accessed at:

In July 2010, the second band began QIS implementation in the following areas: Colorado, District of Columbia, Indiana, Nebraska, New York, Oregon, and Utah.

Much has been learned from long term care providers in the first 16 states in which QIS has been implemented and from many providers in states where it has not. One of the most important is that it takes a long time to learn about how the QIS methods work, and preparation is best achieved by actually conducting the QIS process in each facility.

Following are some guidelines from providers that have used the methods and learned from them: Select a leader to guide the implementation effort; involve staff at all levels and in all disciplines. Use the QIS process as it was designed—broad preliminary assessment followed by in-depth investigation; know that sample selection for Stage 1 may be random or purposefully selected; analyze Stage 1 findings, then investigate Stage 2 areas that trigger in order to focus efforts in areas that have potential quality concerns. Use QIS every day, and make it part of a daily routine—the most successful use is daily, a bit at a time, on an ongoing basis, as in continuous quality improvement. Know that ongoing use keeps up with changing census and conditions in the facility; understand that there will be too much to do if completion is attempted all in a short time frame. Integrate QIS with other quality programs and processes, including care planning and other assessments that address concerns and grievances.

Discuss the results with the quality assurance committee in order to plan corrective actions; act on the results; develop action plans to address identified quality concerns or noncompliance; monitor effectiveness of action plans by repeating assessment processes; and be aware that small changes can make a big difference to residents.

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