Background

• • In 2014, Healthcare Management Solutions (HMS) began helping SAs by deploying a team of uniquely qualified subject matter experts in SA management, survey and certification activities, strategic planning, workload management, training, and use of the Centers for Medicare and Medicaid Services (CMS) Quality Improvement and Evaluation System (QIES).
  • While assisting SAs, one common theme emerged: Although SAs are required to enter almost all survey and certification activities into their state Automated Survey Process Environment (ASPEN) programs, many have difficulty using the systems and ultimately, cannot easily access and utilize their own data.

Problem Areas

• • Existing reports that SAs need for their work are distributed across CMS systems such as CASPER and QCOR that get their data from ASPEN. These reports include those used by CMS for tracking state performance standards system (SPSS) metrics including survey intervals, off-hour surveys for nursing homes, and the timeliness of uploads.
  • The time it takes to complete the survey and related tasks and send the information to these national systems can take weeks or even months.
  • When a problem is discovered, the SA has limited opportunity to correct the issue.
  • SA reporting needs go beyond the basic performance measure requirements to functional reports that aid in overall survey and certification scheduling and oversight as well as high-level summaries the SA leadership needs to ensure their staff are responsive to internal needs and legislative inquiries.

Solution 1: HMS Technical Assistance

• • As HMS identified these issues, we worked with each SA to help them better understand ASPEN by developing and providing SA process-specific supplemental guides and training on ASPEN and each of the QIES systems.
  • We also began developing reports from the ASPEN data to assist the SAs’ oversight of survey and certification workload management and certification and the use of the federal systems.
  • These reports incorporated CMS and State Operations Manual (SOM) guidance and requirements, and systems best-practices. With over 140 years of combined survey and certification experience, the team was able to provide direction and input on pertinence and usability of the reports which empowered SAs by providing real-time, unique insight into their day-to-day work and general oversight.
  • However, the complexity of connecting to the state ASPEN database, and utilization of software and programming language was beyond the technical capabilities of most SAs. Therefore, the ability to update and use these reports was limited to when the HMS team was on site to directly assist the SA.

Solution 2: HMS Software Development

• • HMS developers created the Reporting And Dashboard Application Results (RADAR) application, so we could create and share reports with SAs that they could run as needed.
  • Understanding the issues and needs SAs have with existing systems, HMS developed RADAR to be easy to use and navigate, providing the SA with the ability to easily modify report criteria, add or remove fields, reorder, and even export the results to Excel and Adobe files.
  • RADAR included dashboard-style reporting that enabled SA leaders to easily view relevant metrics in real time.
  • Being forward thinking, HMS developers didn’t stop there. For SAs with staff that can write reports, RADAR’s flexibility allows the SA to include their reports and create their own filters to allow staff to run them as needed, without having to ask the developer to do so for them each time.
  • As implementation of the next phase of CMS iQIES progresses, RADAR will accommodate the changes. With its ability to connect to an Application Program Interface (API), the application will be able to provide the same reporting and customization capabilities for existing and future SAs that HMS assists.

Results

• • Six SAs are actively using RADAR to aid in their survey and certification work with scheduling and tracking surveys, quality assurance activities, Aspen Complaint Tracking System (ACTS) intake monitoring, workload monitoring, and most recently managing the need for rapid information during the pandemic.
  • Since the Summer of 2018, SAs have used RADAR to run more than 5,400 reports. As HMS provides technical assistance to SAs, their ongoing experience is used to continue developing reports and enhancing the system to provide a one-of-a-kind reporting application with the SA in mind.
  • In 2020, HMS continued supporting SAs with our unique blend of SA and survey and certification subject matter expertise and application development, by continuing to develop SA-centric computer and QIES systems training and guides, reports and reporting applications, and complete state licensing systems.

Agencies Involved

• • Centers for Medicare and Medicaid Services (CMS): CMS combines the oversight of the Medicare program, the federal portion of the Medicaid program and State Children’s Health Insurance Program, the Health Insurance Marketplace, and related quality assurance activities.
  • State Agencies (SAs): Each U.S. state and territory has an agency with responsibility for oversight of healthcare facilities, with reporting responsibilities to CMS. HMS provides technical assistance and other services to these state agencies.