Harmony Healthcare Blog

New Long-Term Care Survey Process: QIS vs New Survey Process

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Thu, Aug 17, 2017

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Edited by Kris Mastrangelo

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency


survey-1.jpgAs promised in our previous post, the following tables compare the Quality Indicator Survey (QIS) to the New Survey Process for Automation, Sample Selection, Off-Site Survey Review, Information Needed Upon Entrance, Initial Entry to Facility, Survey Structure and Group Interviews.

Automation: 

Traditional

Quality Indicator Survey (QIS)

New Survey Process

  • Survey team collects data and records the findings on paper
  • The computer is only used to prepare the deficiencies recorded on the CMS-2567

Each survey team member uses a tablet PC throughout the survey process to record findings that are synthesized and organized by the QIS software

Each survey team member uses a tablet or laptop PC throughout the survey process to record findings that are synthesized and organized by new software

 

Sample Selection: 

Traditional

Quality Indicator Survey (QIS)

New Survey Process

  • Sample size determined by facility census
  • Residents are pre-selected based on QM/QI percentiles (total sample)
  • Sample may be adjusted based on issues identified on tour
  •  Maximum sample size is 30 residents
  • Includes complaints

The ASE-Q provides a randomly selected sample of residents for the following:

  • Admission sample is a review of up to 30 current or discharged resident records
  • Census sample includes up to 40 current residents for observation, interview, and record review
  • With QIS 4.04, complaints can be included in census sample
  • Sample size is determined  by the facility census
  • 70% of the total sample is MDS pre-selected residents and 30% of the total sample is surveyor-selected residents.  Surveyors finalize the sample based on observations, interviews, and a limited record review.
  • Maximum sample size is 35 residents

 

Offsite Survey Review: 

Traditional

Quality Indicator Survey (QIS)

New Survey Process

  • Review Casper 3 and 4 reports
  • Survey team uses QM/QIs report offsite to identify preliminary sample of resident’s areas of concern
  • Review the Casper 3 report and current complaints
  • Download the MDS data to PCs
  • ASE-Q selects a random sample of residents for Stage 1 from residents with MDS assessments in past 180 days
  • Each team member independently reviews the Casper 3 report and other facility history information
  • Review offsite selected residents and their indicators and the facility rates.

 

Information Needed Upon Entrance: 

Traditional

Quality Indicator Survey (QIS)

New Survey Process

  • Roster Sample Matrix Form (CMS-802)
  • Obtain census number and alphabetical resident census with room numbers and units
  • List of new admissions over last 30 days
  • Completed matrix for new admissions over the last 30 days
  • Facility census number
  • Alphabetical list of residents
  • List of residents who smoke and designated smoking times

 

Initial Entry to Facility: 

Traditional

Quality Indicator Survey (QIS)

New Survey Process

  • Gather information about pre-selected residents and new concerns
  • Determine whether pre-selected residents are still appropriate
  • 1 – 3 hours on average 
  • No sample selection
  • Initial overview of facility, resident population and staff/resident interactions.
  • 30 – 45 minutes on average for initial overview
  • No formal tour process
  • Surveyors complete a full observation, interview all interviewable residents, and complete a limited record review for initial pool residents:
  • Offsite selected residents
  • New admissions
  • Vulnerable residents
  • Identified Concern that doesn’t fall into one of the above subgroups
  • 8 hours on average for interviews, observations, and screening.

 

Survey Structure: 

Traditional

Quality Indicator Survey (QIS)

New Survey Process

  • Resident sample is about 20% of facility census for resident observations, interviews, and record reviews
  • Phase I:  Focused and comprehensive reviews based on QM/QI report and issues identified from offsite information and facility tour
  • Phase II:  Focused record reviews
  • Facility and environmental tasks completed during the survey
  • Stage 1:  Preliminary investigation of regulatory areas in the admission and census samples and mandatory facility tasks started
  • Stage 2:  Completion of in-depth investigation of triggered care areas and/or facility tasks based on concerns identified during Stage 1
  • Resident sample size is about 20% of facility census
  • Interview, observation and limited record review care areas are provided for the initial pool process; surveyors can ask the questions as they would like
  • Surveyors meet to discuss and select sample, may have more concerns than can be added to the sample; may need to prioritize concerns
  • Investigations are then completed during the remainder of the survey for each sample resident using CE pathways
  • Facility tasks and closed record reviews are completed during the survey

 

Group Interviews: 

Traditional

Quality Indicator Survey (QIS)

New Survey Process

  • Meet with Resident Group/Council
  • Includes Resident Council minutes review to identify concerns
  • Interview with Resident Council President or Representative
  • Includes Resident Council minutes review to identify concerns
  • Resident Council Meeting with active members
  • Includes Resident Council minutes review to identify concerns


Stay tuned for Harmony Healthcare International’s (HHI) next blog post regarding the new survey process and F-Tag Renumbering.

Harmony Healthcare International (HHI) is available to provide assistance You can contact us by clicking here. Looking to train your staff?  Join us in person at one of our upcoming Competency/Certification Courses.  Click here to see the dates and locations. 

Additional Information:

Additional information about the survey process and implementation can be found at: 

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Nursing-Homes.html


So much information, so little time to learn it!
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Tags: QIS, Long-Term Care Survey Process

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