How can we monitor quality at long-term and acute care facilities?

Challenge

CMS’s Quality Safety and Oversight Group (QSOG) provides oversight and ensures compliance for providers serving Medicare and Medicaid beneficiaries. State survey agencies support QSOG by conducting facility surveys to verify compliance with Conditions of Participation or Requirements for Participation, and they complete the certification process and investigate complaints from beneficiaries or their families. For what is referred to as the “survey and certification” process, state survey agencies are required to provide data and reports to CMS via the 10 CMS locations. To assess how well the agencies perform their activities, CMS established a comprehensive set of standards called the State Performance Standards System (SPSS).

This project implements and provides ongoing reports relevant to the SPSS to improve the oversight of provider certification processes and enforcement protocols for long-term care facilities (e.g., nursing homes) and other acute and continuing care providers.

Solution

Westat has produced regular reports for the SPSS to facilitate CMS and CMS locations’ surveillance of state performance to improve oversight of states in real time. We have led technical assistance webinars for CMS locations and state survey agencies and pilot tested recommended changes to the SPSS over time. Through this work, Westat develops the annual SPSS guidance document for CMS and makes ongoing recommendations on how to improve the SPSS to better assess state performance using an objective, data-driven approach.

Results

The distribution of ongoing data reports to CMS locations and state survey agencies has spurred change in the quality of the survey and certification process. Timely data sources help CMS and state survey agencies conduct more frequent reviews of progress on dozens of metrics of state performance relevant to the quality of care provided by nursing homes and acute and continuing care providers nationwide.

This project was begun by Insight Policy Research, and work is continuing by Westat.