Q&A with Craig Bagley, CMS Nursing Home Command Center Lead

Why was the CMS Nursing Home Command Center developed? What are its goals?  

The Nursing Home Command Center was formed in November 2020 during the height of the COVID-19 pandemic to bring CMS data analysts, the Independent Evaluation Contractor (IEC) and Centers for Medicare & Medicaid Services (CMS) leadership together to review the data that drives decisions about nursing home Infection Control/Quality Improvement.

To do that, every week we direct nursing home Targeted Response QIIs (TR QIIs) and Quality Improvement Technical Assistance (QITA) referrals to Quality Improvement Organizations (QIOs) and define the timeline for their reporting back to CMS. Then we synthesize the reported data into dashboards to provide visuals that assist with oversight as well as reporting to CMS management.

Our goal is to inform CMS leadership of the data and trends to help translate that data into action. We collect a lot of information from the QIOs, and the QIOs tell us a lot about what is working. We think carefully about the impact of any decisions and actions on nursing home residents.

How does the work of the CMS Nursing Home Command Center support better care for nursing home residents?

Vaccination rates among nursing home staff are now a large part of our focus. And we continue to track the outbreak of COVID-19 in nursing homes. Nursing Home Command Center referrals send critical QIO resources to nursing homes that need support to help boost staff vaccination rates and contain COVID-19 outbreaks. This helps make nursing homes safer places for their residents and staff.

We hope to share the results of these interventions in an article being considered for publication in a peer-reviewed journal that will show the impacts of last year’s QIO interventions on COVID-19 outbreaks in nursing homes.

How does this data collection help you understand and address the health equity issues that have been brought out by the pandemic?

Collecting that data is one piece of information to help us better understand the health equity issue. I think that’s what we’ll spend the next 3-4 months digging into. CMS leadership has to have data to support its decisions. We are trying to figure out how we can focus CMS efforts in that area.

What is your role at the CMS Nursing Home Command Center? Please give us a snapshot of your daily priorities and the organizations with which you collaborate. 

I manage the weekly referrals to QIOs that assist nursing homes with COVID-19 infection control and help increase vaccination rates among nursing home residents and staff. To support this, I interact daily with QIOs and CMS contracting officer representatives (CORs), direct Nursing Home Command Center meetings and collaborate with the Centers for Disease Control and Prevention (CDC) on its National Healthcare Safety Network (NHSN) data collection efforts. Our team members are individuals who can respond to issues immediately and make rapid-cycle change.

Tell us a little about your professional background, and how it intersects with this work. What advice would you give people who want to work in Quality Improvement?

I was going to go to med school but took an opportunity to work for the government. I started working directly with analysts looking at data on program performance. Ultimately, I got an opportunity to work at CMS with the Peer Review Organizations (which preceded QIOs). We had no data analysis at that time, so I set that up. Then I worked with the QIOs as a COR for over 20 years.

When you’re making decisions about how to do things you need to know exactly how that’s going to impact the folks that are doing it. So I’ve always been comfortable with decision-making based on data. I have a background in health information. And working directly in operations is a big advantage because I know what it’s like to be on the receiving end of recommendations.

If you’re going to work in nursing home quality, it helps if you were a provider of some sort and have direct experience in the area you want to improve. I think that’s a big advantage, because once you work there you have a million ideas about how to make things better. An understanding of management information is also essential to Quality Improvement.

Submitted by Craig Bagley on behalf of CMS.