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Why Is Training Slowing?

Dr. Andy Kramer
Provider Magazine – February 2012


Why did CMS stop the QIS training in New Jersey, South Carolina and Arkansas?


With half the states now trained in QIS and some Regional Office surveyors trained in each region, there have been many successes with respect to QIS, and also many obstacles to overcome. As the Centers for Medicare & Medicaid Services QIS surveyor training contractor, Providigm staff have worked through these obstacles with CMS, and a great deal has been learned about State and Regional Office training and implementation.

CMS appropriately wants to ensure that QIS is being fully and properly implemented in all the trained QIS states with optimal federal oversight. They want to optimize the training model, improve oversight, and reduce technological issues. In addition, with pressure to reduce spending in both state and federal governments, it is time to look at ways of increasing efficiency in the conduct of QIS.

In a recent survey and certification letter Thomas Hamilton states:

“We will stretch out the timeline for adding new states to the Quality Indicator Survey (QIS) for nursing homes, and concentrate on fully and effectively implementing the QIS in those states that are already implementing the system.”

The added value and survey consistency that CMS sees in QIS based on the experience to date is also referenced in this letter in a continuation of this section:

“We consider the QIS to add considerable value and prospects for improved consistency in the survey process. These advantages are due to a number of notable design features, such as its greater use of data for each nursing home, greater resident sample sizes, more structured survey protocols, tools for quality improvement, and ability to tailor on-site time according to the seriousness of the initial findings.” In a further continuation of this section, CMS clearly states its commitment to QIS as the survey and certification process for nursing facilities:

“Heretofore we have also had to accomplish implementation of QIS as a sideline to the survey & certification operational budget, but for the future we will renew efforts to raise the QIS as a stand-alone item worthy of distinct budget treatment.”

When you think of the evolution that QIS requires in nursing facilities toward a more resident-centered and continuous quality improvement/assurance program, it should not be surprising that the survey and certification program is undergoing a major change as well. This requires a commitment to change for all parties that will result in a higher and more rigorous quality standard.

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