CMS revises standards to strengthen oversight of nursing home inspections

As part of CMS’s efforts to improve nursing home resident safety and respond to concerns about inconsistent and untimely inspections, CMS has revised the State Performance Standards System (SPSS) process. The updates to the SPSS aim to enable CMS and State Agencies to address areas of concern more effectively and ultimately improve beneficiary safety and the quality of their care (CMS Letter to State Survey Agency Directors, Admin Info: 20-02-ALL, October 17, 2019).

Structural changes

Included in the changes to the SPSS guidance is a new non-scored tier of measures that includes frequency run-rates and State Performance Indicators. Frequency run-rates measure goals during the fiscal year will be published in the form of a quarterly data extract. These frequency run-rates will be useful to assess mid-year progress made towards meeting Frequency measures during the fiscal year. The State Performance Indicators will help identify underlying causes for inadequate performance in one or more of the scored performance measures.

Domain changes

Within the Frequency Domain, a new process for State Survey Agencies to request permission from CMS to exclude surveys from frequency measure calculations is included in the guidance. It was also updated to include an evaluation of the timely completion of initial certification surveys for the End Stage Renal Disease (ESRD) program. Sub-domains were established within the Quality Domain that focus on the standard survey and complaint survey processes, separately. The method of evaluating and the criteria associated with the documentation of deficiencies was revised to reduce subjectivity and burden. Finally, the Enforcement Domain was renamed “Coordination of Provider Noncompliance,” to more accurately reflect the role of State Survey Agencies.


The guidance provides instructions to Regional Offices on how to evaluate State Survey Agency performance. Measures should be calculated according to the specific instructions for each measure in the guidance and the scores should be entered into the database within the CMS SharePoint site. The guidance provides a timeline for the evaluation period along with deadlines. For each measure that is scored as “not met,” the State Survey Agency should develop and implement a corrective action plan that will address identified problems. The guidance also provides direction as to how and when the Regional Office should follow-up on progress toward making corrections.

The Joint Commission 2016 quality report shows gains, emphasizes easier reporting options

Hospitals have made significant progress in meeting quality measures newly added to The Joint Commission’s (TJC) annual report, and many measures have been retired due to hospitals meeting them so successfully. More flexible options for performance reporting that better align with CMS’ Hospital Inpatient Quality Reporting Program were implemented to ease reporting burdens, and TJC is committed to continually providing quality improvement resources for hospitals. In America’s Hospitals: Improving Quality and Safety – The Joint Commission’s Annual Report 2016, measures for inpatient psychiatric services, tobacco use treatment, substance use care, and influenza immunization have shown significant gains.


In 2015, TJC introduced flexible options for reporting electronic clinical quality measures (eCQMs) and chart-abstracted measures. The Pioneers in Quality™ program was introduced and coordinated with the Core Measure Solution Exchange® in order to support hospitals transitioning to eCQM reporting. The Pioneers in Quality program provides resources to hospitals, including educational content, an advisory panel, and outreach. The Core Measure Solution Exchange is a collaborative online network developed for TJC-accredited hospitals to promote performance measurement success stories.


TJC uses a composite score result that sums up individual results into a summary score in order to demonstrate improvement. The overall composite score declined from 97.2 percent in 2014 to 93.7 in 2015 due to the retirement of high-scoring measures, resulting in some difficulty in comparing results.

The inpatient psychiatric services composite score, made up of several underlying measures from admission screening to multiple antipsychotic medication justification, has improved by 3 percentage points since 2011, ending at 90.3 percent for 2015. The stroke care composite score was already high at 94.9 percent in 2011, but has improved to 97.7 percent. Perinatal care scores have improved drastically since 2011, from 53.2 percent to 97.6 percent. Tobacco and substance use treatment and care results have only been measured for two years, but have seen gains of several percentage points in all measures.