10/3/2017 FALL 2017 MDS AND SURVEY UPDATES OBJECTIVES:

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1 FALL 2017 MDS AND SURVEY UPDATES October 5th, 2017 By Cil Bullard RNC, CPC, RAC-CT, State RAI/OASIS Coordinator (preferred): Phone: OBJECTIVES: Briefly review the new LTC Survey process and the implications for MDS coding Review common Survey citations and MDS coding issues in Virginia Review changes for Section S effective 10/1/17 PHASE 2 OF THE REVISED SURVEY PROCESS STARTS 11/28/17 You can find the new Appendix PP, CMS training, the revised F-tag list, the new Matrix, and other important information at: and- Certification/GuidanceforLawsAndRegulations/Nursing -Homes.html 1

2 WHERE ELSE IS THERE INFORMATION? raining.aspx This site has lots of helpful web-based training available for the public-check dates please. The learning modules that surveyors used can be found by searching for 0CMSLTCSME_VID at this site CRITICAL PATHWAYS(CP) These are located at the CMS website: Enrollment-and- Certification/GuidanceforLawsAndRegulations/Nur sing-homes.html CP take the surveyor through an analysis to determine if a deficiency exists- a similar tool has been used in the QIS survey process for several years USE OF THE MDS IN PHASE 2 Some of the ways that surveyors gather and analyze data have changed The software compares MDS data before the survey team enters, and calculates 70% of the initial residents sampled- the surveyors come in and look at this 70%, then add/remove some residents If your MDS assessments aren t accurate, the surveyors will be able to compare the resident to the MDS data on the spot 2

3 PLEASE NOTE: The graphics of Surveyor software are composites of several screens, and completely ficticious. Bill Gates MDS Indicators Specific MDS indicator/section MDS DISCREPANCY Whatever data the MDS DATABASE shows for the item being investigated Comments: All the various care areas All CP that apply based on most recent MDS HOW DOES ASSESSMENT ACCURACY IMPACT THE SURVEY STARTING 11/28/17? Let s walk through a typical surveyor task making rounds soon after entering the facility. (If you haven t seen it yet, CMS posted the LTC Survey Procedure guide on the Guidance for Laws/Regulations page as shown earlier) 3

4 WHILE MAKING ROUNDS IN THE FACILITY To screen residents for the initial pool, introduce yourself and briefly converse with the resident (e.g., ask how they are doing) while you complete a quick head-to-toe observation. Review their MDS indicators and/or matrix information before entering the room to give you a more complete picture. SO FOR EXAMPLE, MS PRETTY: The MDS lists the resident as rarely/never understood, the interviews are skipped and staff interviews are done When the surveyor visits the resident, the resident can hold a simple conversation with the surveyor The surveyor immediately checks the MDS discrepancy box, and the software will activate the resident for further investigation Ima Pretty MDS Indicators Makes self understood(b0700) 9/1 QTR: rarely never understood 6/1 QTR: rarely never understood 3/1 ANN sometimes understood Comments: All the various care areas MDS DISCREPANCY All CP that apply based on most recent MDS 4

5 Let s look at the Resident Assessment Pathway for Ms. Pretty. RESIDENT ASSESSMENT REGULATIONS WILL BE F636 F644: F636 Comprehensive Assessments F637 Comprehensive Assessment after SCSA F638 Quarterly Assessment every 3 months F639 Maintain 15 months of Resident Assessments F640 Encoding / Transmitting Resident Assessments F641 Accuracy of Assessments F642 Coordination / Certification of Assessment F644 Coordination of PASRR and Assessments THIS NEW SURVEY IS MORE LIKE THE QIS: Both are tablet based and require the surveyor to use a MDS-database initial sample Both provide tightly structured assessment tools CMS is going to have one type of survey across the Nation, that has attributes of both the QIS and Traditional surveys 5

6 PER THE CMS QIS EVALUATION MEMO: The QIS was associated with an increase in the number of survey deficiencies The QIS was associated with an increase in G-level deficiencies The QIS was associated with an increase in the regulatory care areas cited MDS TIPS FOR THE NEW SURVEYS: MDS inaccuracies are going to be cited more Duplicate residents are going to cause issues with the census, sample size, and MDS data, so monitor your Roster and Missing Assessment reports in CASPER Room numbers(a1300) are optional, but helpful to surveyors TOP 10 CITED DEFICIENCIES IN 2016 Calculated statewide, for all certified Nursing Facilities 287 providers total 6

7 149 # with this deficiency in 2016 SPECIFIC F-TAG DATA: F 514 Resident records complete/accurate/accessible has been the SECOND most cited tag every year since 2011 In 2016, 53.5% of providers were cited with this deficiency 149 providers total This tag is now crosswalked to: F842, (483.70(i)1)(5) 7

8 F-279 DEVELOP COMPREHENSIVE CARE PLANS New entry to the Top Ten list last year Cited in 69 facilities, which is 24.4% of all Virginia certified nursing facilities Now crosswalked to F639/Maintain 15mo of Assessments F656/ Develop & Implement Comprehensive Care Plan F-278- ASSESSMENT ACCURACY/ COORDINATION /CERTIFIED Has been in the Top 10 most cited deficiencies every year since 2011, usually between #5 and #8 Last year 86 providers, or 30.9% were cited SECTION S: DMAS has released 2 memos on Section S. Go to the DMAS nursing facility page at and click on the two top links: 8

9 LET S REVIEW THE INSTRUCTIONS TOGETHER: If you did not print out the instructions, they are going to be on screen. And the clarification. QUESTIONS? DISCUSSION? Please remember my contact info in the first slide and that is best. 9