11/23/2011. Proactive vs. Reactive Relationship

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1 Overview Focus on Resident Voice Assessment Schedule EOT OMRA and New Resumption Items New PPS Assessment: COT OMRA CMS Clarifications Coding New Quality Measures Draft MDS and Care Planning as Risk Management Involve resident and family in care plan meetings. Document resident and family satisfaction with care delivery. Use the care plan to develop relationships with residents! Incorporate resident responses from MDS interviews into care plan AND in care delivery. 1

2 Proactive vs. Reactive Relationship Positive vs. Negative interactions build positive instead of negative relationships. If a phone call at midnight is your first or interaction this sets a negative tone. If you interaction is always problem based You will build a negative relationship. Move toward families and resident when things are going well, not just when there are problems! Decreases risk by creating positive interactions leading to positive relationships. What do you do to create a positive relationship with the resident and family? Seek out reasons to contact families with positive information from your assessment and care plan Make it easy for family and residents to attend care plan meetings. Schedule to their convenience not yours. Inform families of what you re doing for their loved one. Utilize the family s knowledge of the resident. Remember to give yourself credit for what you do! Document attendance of family and resident in the care plan process. Sign care plan attendance record or sign the care plan. Document how you will accommodate preferences in the care plan. 2

3 COT OMRA Clarifications COT OMRA and Day of Discharge If Day 7 of the COT observation period is also the day of discharge, then a COT OMRA would not be required. COT OMRA and Scheduled PPS Assessments If the ARD of a scheduled PPS assessment is set for on or prior to Day 7 of the COT observation period, then no COT OMRA would be required. COT OMRA Clarifications COT OMRA and Index Maximization In some situations a resident may simultaneously meet the qualifying criteria for both a therapy and a nontherapy RUG. For some of these cases the RUG-IV per diem payment rate for the non-therapy RUG will be higher; therefore, although the resident is receiving therapy services, the index maximized RUG is a nontherapy RUG. A facility is required to complete a change of therapy evaluation for all patients receiving any amount of skilled therapy services, including those who have index maximized into a non-therapy RUG group. COT OMRA Index Maximization What does that mean? Evaluate. Decide if a COT OMRA is needed or not needed! *RTM s *Number of Therapy Disciplines *Number of Therapy Days *Restorative Nursing (Low Rehab) 3

4 A COT OMRA is only required for residents in such cases that the therapy services received during the COT observation period is no longer reflective of the RUG-IV category after considering index maximization. Consider the following two examples: Example #1: Resident qualifies for RMB but index maximizes into HC2. During the COT observation period, resident receives only enough therapy to qualify for RLB. COT OMRA not required because no change to index maximized RUG category Example #2: Resident qualifies for RMB but index maximizes into HC2. During the COT observation period, resident receives enough therapy to qualify for RUB. COT OMRA is required because of change to index maximized RUG 4

5 See attachment COT OMRA Clarifications Completing resident interviews on COT OMRA Providers are encouraged to complete resident interviews e in as timely a manner as possible, which in the case of a COT OMRA might occur 1-2 days after the ARD of the COT OMRA. Every effort should be made to provide the residents an opportunity to make their voices heard! Leave of Absence (LOA) Policy Clarification Scheduled PPS Assessments The Medicare assessment schedule is adjusted d to exclude the LOA when determining the appropriate ARD for a given assessment. 5

6 Example: A resident leaves SNF X at 6:00pm on Wednesday (Day 27) and returns to the SNF on Thursday at 9:00am. Wednesday becomes a non-billable day and Thursday becomes Day 27 of the resident s stay. Leave of Absence (LOA) Policy Clarification Unscheduled PPS Assessments Days during which a resident experiences an LOA must be counted toward the ARD for a given unscheduled assessment. EOT OMRA Example: A resident does not receive therapy on Monday and Tuesday, and Wednesday, goes to the emergency room at 9:00pm on Wednesday and returns to the facility on Thursday at 10:00am, Whether or not therapy is provided on Thursday, an EOT OMRA would be required with an ARD set for Monday, Tuesday, or Wednesday. 6

7 Leave of Absence (LOA) Policy Clarification Unscheduled PPS Assessments Days during which a resident experiences an LOA must be counted toward the ARD for a given unscheduled assessment. COT OMRA Example: If the ARD for a resident s 30-day assessment were set for November 7 and the resident went to the emergency room at 11:00pm on November 9, returning at 2:00pm on November 10, Day 7 of the COT observation period would remain November 14. Note: The COT evaluation process and payment implications remain unchanged. Leave of Absence (LOA) Policy Clarification Question: Can the ARD set of an unscheduled PPS assessment be set for an LOA day? 7

8 Leave of Absence (LOA) Policy Clarification Answer: Yes; it is possible that the ARD for a given unscheduled PPS assessment may be set for an LOA day. Leave of Absence (LOA) Policy Clarification Question: If a resident experiences an LOA during the observation period for an assessment, can the services provided d to that resident during the LOA be coded on the MDS? Leave of Absence (LOA) Policy Clarification Answer: Yes; such services may be coded on the MDS, though only in those cases where doing so would not violate any other provisions of the RAI manual or other such SNF PPS guidelines. 8

9 Leave of Absence (LOA) Policy Clarification Scenario: A resident leaves the SNF for the emergency room on Monday at 9:00pm and returns on Tuesday at 11:00am. A COT evaluation is done on Thursday. If therapy was provided early Monday morning, can this therapy be coded on the MDS? Leave of Absence (LOA) Policy Clarification Solution: Yes; therapy provided by the SNF on the day the resident experiences the LOA may be counted toward the COT evaluation. Use of Dashes for Interviews. Every effort should be made to interview the resident on or before, or as near to the ARD as possible. In circumstances where discharge occurs unexpectedly and the interview cannot be completed. Follow instructions from CMS Memo. 9

10 See Attachment Section D.0300, Mood (PHQ-9) Notify Mental Health Specialist for any score > 12. Section D I. and D I. Involve Physician for any yes and coding 1, 2, or 3 ; for better off dead... Section E.0800, Rejection of Care & Frequency Instructions in the manual changed, page E-15 of Chapter 3. Prior RAI Manual wording used was- and/or 10

11 Section E.0800, Rejection of Care & Frequency Current RAI Manual Update: Do not include behaviors that have already been addressed (e.g., by discussion or care planning with the resident or family) and are determined to be consistent with resident values, preferences or goals. Section F0400.A-H., Preferences for Customary Routine and Activities Utilize responses in your activity care plan to demonstrate t you have incorporated Resident Voice into your care delivery. *Very Important *Somewhat Important Section F0400.A-H., Preferences for Customary Routine and Activities Resident Responses Important but can t do or no choice should have significant ifi clarification in the record!! 11

12 Section H., Bladder and Bowel Associated F-Tags: *F315 *353 *501 J0300, J0400, J0500, J0600; Pain Must use resident s responses to these questions in establishing and adjusting resident s pain management regimen as reflected at the time of the ARD! O0250 and O0300, Flu/Pneumovax Associated F-Tag: *F334 12

13 SCSA-Significant Change in Status Assessment Must be completed upon any resident enrolling in Hospice regardless of whether any significant change in status criteria are met. Chapter 2, Section 2.6, page Research Triangle Institute International Most recent Draft Dated Subject to Change Short Stay 11 Measures Qualifying Reasons for Target Assessment *Admission, i Annual, SCSA, Quarterly, Significant Correction, Quarterly, DC- RA, DC-RNA *5-Day, 14-Day, 30-Day, 60-Day, 90- Day, Readmission/Return Assessment 13

14 Short Stay Qualifying Reasons for Initial Assessment *Admission, 5-Day, Or Readmission/Return assessment, DC-RA, DC-RNA Long Stay 18 Measures Qualifying Reasons for Target Assessment *Admission, Annual, SCSA, Quarterly, Significant ifi Correction(Comprehensive i or Quarterly, DC-RA, DC-RNA *5-Day, 14-Day, 30-Day, 60-Day, 90- Day, Readmission/Return assessment Flu and Pneumococcal Vaccines Measures Currently, account for Eight Measures under Short and Long Stay Categories! 14

15 Flu and Pneumococcal Measures % of residents assessed and appropriately given the seasonal flu vaccine. Flu and Pneumococcal Measures % of residents who received the seasonal flu vaccine. Flu and Pneumococcal Measures % of residents who were offered and declined the seasonal flu vaccine. 15

16 Flu and Pneumococcal Measures % of residents who did not receive, due to medical contraindication, the seasonal flu vaccine. Flu and Pneumococcal Measures % of residents assessed and appropriately given the pneumococcal vaccine. Flu and Pneumococcal Measures % of residents who received the pneumococcal vaccine. 16

17 Flu and Pneumococcal Measures % of residents who were offered and declined the pneumococcal vaccine. Flu and Pneumococcal Measures % of residents who did not receive, due to medical contraindication, the pneumococcal vaccine. Remaining Three Short Stay Measures Falls Pain Pressure Ulcers 17

18 Short Stay Measures Pain: % of residents on a scheduled pain medication regimen on admission who self-report a decrease in pain intensity or frequency. Short Stay Measures Pain: % of residents who self-report moderate to severe pain. Short Stay Measures Pressure Sores: % of residents with pressure ulcers that are new or worsening. 18

19 Remaining Ten Long Stay Measures *Falls *Catheters *Pain *Restraints *Pressure Ulcers *ADL s *Urinary Tract Infections *Weight Loss *Bladder or Bowel *Mood Long Stay Measures Pain: % of residents who self-report moderate to severe pain. Long Stay Measures Falls: % of residents experiencing one or more falls with major injury. 19

20 Long Stay Measures Pressure Ulcers: % of high-risk residents with pressure ulcers. Risk Adjustment: Long Stay Measures Urinary Tract Infections: % of residents with a UTI Long Stay Measures Bladder/Bowel: % of low-risk residents who lose control of their bladder or bowel. Risk Adjustment: 20

21 Long Stay Measures Catheters: % of residents who have/had a catheter inserted and left in their bladder. Long Stay Measures Restraints: % of residents who were physically restrained. Long Stay Measures ADL s: % of residents whose need for help with activities iti of daily living i has increased. 21

22 Long Stay Measures Weight Loss: % of residents who lose too much weight. Long Stay Measures Mood: % of residents who have depressive symptoms. Research Triangle Institute International: National Provider Call Slides from : 22

23 MDS 3.0 CMS: HQIMDS30TrainingMaterials.asp# Dashes CMS: nloads/mds30theuseofdashes.pdf 23