U.S. Senators Chuck Grassley, R-Iowa, and Herb Kohl, D-Wis., today released a report urging the Centers for Medicare and Medicaid Services (CMS) to improve oversight of the new system being created to monitor the quality standards in nursing homes.
The Government Accountability Office (GAO) report, entitled, "Nursing Home Quality: CMS Should Improve Efforts to Monitor Implementation of the Quality Indicator Survey," urges CMS to improve efforts to monitor implementation of the Quality Indicator Survey (QIS) for nursing homes.
CMS started moving toward the QIS process in 2005 after reports indicated a need for improvements in the traditional survey process. But the agency has decided to temporarily suspend implementation until a number of concerns raised by states and regional CMS offices have been resolved.
"The report shows CMS doesn't do enough to monitor and facilitate states' implementation progress," Grassley said. "After six years of implementation, 26 states had trained or started training surveyors to use the system, but uncertainty about progress by these states led CMS to suspend implementation for the rest of the country. If CMS were better tracking state implementation from the beginning, the agency could have identified these problems earlier and helped the states that are struggling."
"There's an obvious need for a clear, consistent and efficient system for monitoring nursing home quality," Kohl said. "QIS has the right goals in mind, and has the potential to make a positive difference in the consistency and accuracy of state survey work across the country -- but implementation needs to be done well, and the agency's goals need to be realized sooner rather than later."
Grassley and Kohl have worked together on nursing home quality for many years. Most recently, their bill, the Nursing Home Transparency and Improvement Act of 2009, was passed into law. Through the Senate Special Committee on Aging, the senators have pressed the federal government and states to improve the quality of nursing home care through more rigorous inspections and better information about inspection results for consumers through the federal Nursing Home Compare database. Kohl is chairman of the Aging Committee. Grassley is former chairman. A landmark GAO report from 1998 was the subject of Aging Committee hearings Grassley convened. The hearings exposed serious quality of care problems in nursing homes, exacerbated in part by highly predictable annual inspections and few citations for serious deficiencies. After the hearings and at the urging of the Aging Committee, the Clinton Administration took steps to improve the inspection process. Grassley and Kohl have urged continued attention and refinements.