Long-Term Care Survey Alert

Nursing facilities might find their relationship with quality improvement organizations and state survey agencies reminiscent of being caught between two parents with different agendas: One wants you to do new things to improve and the other will ground you if you don't go by the book. However, QIOs are aware that they will have to get on the same page with surveyors in order to counsel facilities about new practices to improve their care and resident outcomes.

QIOs will be working with a subset of 10 to 15 percent of facilities on a voluntary basis in each state on selected quality measures, such as pain management. They also will provide assistance to any facility that requests it or to those identified by state survey agencies as in need of quality improvement.

For the initiative to succeed, QIOs and SSAs must work together, David Gifford, a geriatrician and chief clinical officer for the Rhode Island QIO, tells Eli. "For example, QIOs must make sure they are not promoting practices prohibited by the regulations. There'd be nothing more confusing to nursing homes than getting conflicting messages from two different government agencies."

But some believe there should be a healthy tension between QIOs and surveyors if the former introduce leading-edge innovations that might, in some cases, challenge "old school" survey ideas and methods. Gifford doesn't foresee that scenario unfolding, however.

"The QIOs will be spending less time focusing on innovations in care and more on how facilities are providing care consistent with state survey agency activities," he says. "Also, the regulations rarely prohibit specific care practices, unless they are proven ineffective or harmful," Gifford adds.

Since the quality measures are derived from residents' minimum data sets, QIOs and state resident assessment instrument coordinators will also have to work in tandem to help facilities improve MDS accuracy, Gifford maintains. The QIOs can help facilities understand how the MDS is used to calculate the QMs and how to improve MDS coding reliability and accuracy. "But questions about coding in specific scenarios will be best answered by the RAI coordinators," Gifford says.