MDS Success: An MDS 3.0 Primer Presented by: Rena R. Shephard MHA, RN, RAC-MT, C-NE President & CEO RRS Healthcare Consulting Services 1 Faculty Disclosure I have no financial relationships to disclose I have no conflicts of interest to disclose I will not promote any commercial products or services 2 Copyright 2015 Sponsorship Disclosure This webinar is supported, in part, by a sponsorship from Real Time Medical Systems. Real Time Medical Systems has in no way influenced or biased the content of this learning activity. 3 Copyright 2015 1
Requirements for Successful Completion 1.5 contact hours will be awarded for this continuing nursing education activity. The American Association of Nurse Assessment Coordination is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center s Commission on accreditation. Criteria for successful completion includes attendance for at least 80% of the entire event and submission of a completed evaluation form. Partial credit may not be awarded. Approval of this continuing education activity does not imply endorsement by AANAC or ANCC (American Nurses Credential Center) of any commercial products or services. 4 Copyright 2015 Learning Objectives 1. Interpret the regulatory mandate for the Minimum Data Set (MDS) 2. Differentiate the various functions of the MDS and their application in nursing homes 3. Describe the components of the Resident Assessment Instrument (RAI) process 4. Demonstrate comprehension of key aspects of RAIspecific lingo 5. Explain the process for accurate and timely completion of the MDS 6. Describe how the RAI process is linked to resident care and positive outcomes. 5 Copyright 2015 The Minimum Data Set (MDS) 6 Copyright 2015 2
Minimum Data Set Paper form or software version Must be submitted electronically to national MDS database known as QIES ASAP Core set of resident specific screening, clinical, and functional status items Screening tool rather than assessment Complex completion instructions and processes involved 7 Copyright 2015 Minimum Data Set Item Set Set of MDS items required depending on the reason for doing the assessment Nursing Home Comprehensive (NC) item set Contains the most items, used for clinical assessment Subsets of the NC items set Quarterly clinical assessment Discharge assessments Payment assessments Entry and Death records 8 Copyright 2015 Minimum Data Set Sections A Z: Topics Mandated by Law A. Identification Information B. Hearing, Speech, and Vision C. Cognitive Patterns D. Mood E. Behavior F. Preferences G. Functional Status H. Bladder and Bowel I. Active Diagnoses J. Health Conditions K. Swallow/Nutrition L. Oral/Dental M. Skin N. Medications O. Special Treatments P. Physical Restraints Q. Participation/Goals V. CAAs/Signatures X. Correction Request Z. Assessment Admin 9 Copyright 2015 3
Minimum Data Set Item Set Each section is further divided into specific items Example, Section E, Behavior (page 11) Item E0100, Potential Indicators of Psychosis Item E0200, Behavioral Symptoms Item E0300, Overall Presence of Behavioral Symptoms Item E0500, Impact on Resident Item E0600, Impact on Others Item E0800, Rejection of Care Etc. 10 Copyright 2015 Minimum Data Set After each item label, list of answer options, such as: E0100. Potential Indicators of Psychosis E0100A. Hallucinations E0100B. Delusions E0100Z. None of the above OR 11 Copyright 2015 Minimum Data Set Further subdivided into more questions and the answer options: E0500: Did any of the identified symptoms: E0500A. Put the resident at significant risk for physical illness or injury? Yes/No E0500B. Significantly interfere with the resident s care? Yes/No E0500C. Significantly interfere with the resident s participation in activities or social interactions? Yes/No 12 Copyright 2015 4
Minimum Data Set Answer Options Coding conventions Check all that apply, such as E0100, or Select code and enter it into box, such as A0310 (p. 1), or Enter ID numbers, such as A0100 (p.1) or A0600 (p.2) Message here is to be sure to read coding instructions for each item 13 Copyright 2015 Resident Assessment Instrument (RAI) 14 Copyright 2015 Resident Assessment Instrument (RAI) Regulatory Mandate Nursing Home Reform Act of 1987 known as OBRA 87 Standardized, periodic functional status assessments required for all nursing home residents To improve quality of assessment Spotlighting resident specific problems Targeting care planning Goal: Improving resident care and outcomes 15 Copyright 2015 5
Resident Assessment Instrument Process of Investigation Parallels nursing process Components Minimum Data Set (MDS) Core set of screening, clinical, & functional status items Care Area Triggers (CATs) MDS items that alert staff to possible problems, needs, strengths Triggers need for a complete assessment of the issue that meets standards of practice 16 Copyright 2015 Resident Assessment Instrument Process of Investigation Care Area Assessments (CAAs) 20 care areas (MDS page 36) Complete assessments of issues identified by the MDS Identify causes, contributing factors, risk factors related to the problem Care Plan Working action plan that targets specific problems & needs, including those identified by the MDS & CAAs 17 Copyright 2015 Resident Assessment Instrument Assessment Requirement Comprehensive assessment MDS + CAAs Required at least every 366 days Quarterly assessment Subset of comprehensive assessment Required at least every 92 days Unscheduled comprehensive assessments Significant Change in Status Assessment Significant Correction of Prior Assessment 18 Copyright 2015 6
Resident Assessment Instrument Assessment Requirement OBRA required clinical assessments Required for all residents of nursing home facilities and units in facilities that are Medicare and/or Medicaid certified regardless of payer 19 Copyright 2015 Skilled Nursing Facility Prospective Payment System (SNF PPS) 20 Copyright 2015 SNF Prospective Payment System Regulatory Mandate Federal law mandated switch from cost based to casemix reimbursement in 1998 Cost based = pay facility whatever it spends on the resident s care Casemix prospective reimbursement = predict cost of care using resident specific information from MDS and pay facility based on that 21 Copyright 2015 7
SNF Prospective Payment System Calculating Payment Nursing Home PPS (NP) item set Specific items reflecting resident s acuity used to help quantify the cost of care and services, such as Functional status Health conditions Diagnoses Certain treatments, procedures 22 Copyright 2015 SNF Prospective Payment System Calculating Payment Completed assessment classifies resident into one of 66 categories known as Resource Utilization Groups (RUGs) Residents in a specific RUG share a common projected cost of care Specific diagnoses, treatments, etc. may be very different A daily payment rate is assigned to each group 23 Copyright 2015 SNF Prospective Payment System Assessment Required Law mandates set schedule for SNF PPS assessments to periodically recalculate RUG At approximately day 5, 14, 30, 60, & 90 as long as Part A is the payer Recalculation of RUG also required offschedule under specific circumstances This schedule is in addition and parallel to the OBRA required clinical assessments 24 Copyright 2015 8
Quality Measures (QMs) 25 Copyright 2015 Quality Measures Intended to reflect quality of care in a facility CMS pulls data specific to particular conditions and problems from national database examples Rate of UTIs in a facility comes from I2300 Decline in ADLs computed from comparing G0110 data on successive assessments 26 Copyright 2015 Quality Measures Long list of QMs, scores periodically updated Complex formulas and calculations involved Quality Measures info and User s Manual: www.cms.gov/medicare/quality Initiatives Patient Assessment Instruments/NursingHomeQualityInits/NHQIQuality Measures.html 27 Copyright 2015 9
Quality Measures Publicly Reported QMs Takes facility specific resident care information directly to consumers Publicizes the differences in quality to assist consumers in selection of a facility Nursing Home Compare website www.medicare.gov/nursinghomecompare/se arch.html 28 Copyright 2015 Quality Measures CASPER Reporting System Certification and Survey Provider Enhanced Reporting (CASPER) system Produces QM reports for facility to use in quality improvement efforts Surveyors also use similar list of QMs as part of the survey process 29 Copyright 2015 30 Copyright 2015 10
RAI User s Manual: THE authoritative resource for all official instructions & information Chapters: 1: Overview 2: Timing and scheduling of assessments 3: Item by item coding instructions 4: Care Area Assessments and care planning 5: MDS correction policy and transmission 6: RUG IV calculations 8 appendices 31 Copyright 2015 Download RAI User s Manual from CMS website http://www.cms.gov/medicare/quality Initiatives Patient Assessment Instruments/NursingHomeQualityInits/MDS30RAIM anual.html 32 Copyright 2015 AANAC s RAI User s Manual Web Page www.aanac.org/information resources/mds30/ 33 Copyright 2015 11
Chapter 3 Process based on the standard format for the instructions for each item Background included for each item Intent/reason for including item on MDS Rationale/purpose for assessing the topic How the topic of the item affects quality of life How assessment of the topic can contribute to appropriate care planning 34 Copyright 2015 Chapter 3 Item specific coding instructions Steps for assessment: Sources for information and methods for determining the correct code Specific coding instructions with explanation of individual response options Coding tips/clarifications, issues of note, conditions to be considered Case examples 35 Copyright 2015 36 Copyright 2015 Example See Handout 12
37 Copyright 2015 Timeframe for Data Collection Based on Assessment Reference Date (ARD), item A2300 (p. 5) Last date for collecting data for the particular MDS Most items look back 7 days: ARD plus the 6 days preceding it This is the observation or assessment or look back period (these terms are synonymous) Using the wrong dates or not using every day in the look back is likely to result in accuracy problems 38 Copyright 2015 Who Takes Part in MDS Process? A registered nurse must conduct or coordinate each assessment with the appropriate participation of health professionals (42CFR483.20[h]) It must be an RN who signs item Z0500A certifying completion of all of the MDS items (483.20([I]) This is not verifying accuracy of the items 39 Copyright 2015 13
Who Takes Part in MDS Process? the physical, mental and psychosocial condition of the resident determines the appropriate level of involvement of physicians, nurses, rehabilitation therapists, activities professionals, medical social workers, dietitians, and other professionals, such as developmental disabilities specialists, in assessing the resident, and in correcting resident assessments. Involvement of other disciplines is dependent upon resident status and needs (interpretive guidelines, 42CFR483.20[h]) 40 Copyright 2015 How is Accuracy Validated? Chart documentation that supports the MDS coding Any surveyor or auditor reading the chart should come up with the same coding decision as the person who coded the MDS 41 Copyright 2015 Resident Assessment Instrument Application Activity Incontinence Post Webinar Follow up Activity See Handouts 42 Copyright 2015 14
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