At the Finish Line: The Race to the MDS 3.0

Marcie Stoup, RN, WCC, NHA

Affinity Health Services, Inc.

Objectives

• To assess your facility’s readiness for the MDS 3.0

• To embrace change and celebrate successes

• To plan for growing pains

• To evaluate and re-energize

• To anticipate future challenges

• Meet the Nine Day Challenge

The Race to the MDS 3.0 • Do you know?

Every section on the MDS 3.0 has changed? That it takes an average of 62 minutes to complete the MDS 3.0 There are 4 major resident interviews that are scripted? That CAA is a Care Area Assessment and they replace the RAPs? That the Nursing Home Comprehensive Item Set is 38 pages? That Restorative Nursing is very important financially? That RUG-IV has 66 groupers? That there is a new Discharge Assessment? That the Quality Indicators Measures will not be available? That the MDS 3.0 is the catalyst to Culture Change initiatives

and that Culture Change is the future of Quality of Care and Quality of Life?

The Race to the MDS 3.0

• Roadmap checklist Contact your MDS software vendor Perfect your ADL coding now; assess your

documentation / tracking process / are you getting accurate information or losing money

Assess your current pain management program by utilizing the MDS 3.0 RAI Manual section J and update / check policies and procedures / Pain scale used?

Provide wound care training on staging and documentation; investigate who is staging and is it accurate?

Utilize pressure ulcer best practices with updated staging guidelines that includes DTI

The Race to the MDS 3.0

• Roadmap checklist Prepare for the change in your pressure ulcer statistical

information when the stages will suddenly change back to a Stage 2,3 or 4

Prepare for the changes to the physician documentation of Diagnosis Status; active or inactive

Maintain quality of care and quality of life by conducting staff, resident and family satisfaction surveys

Meet with your therapists and make sure they have copies of Section O / changes in coding / practice changes

The Race to the MDS 3.0

• Roadmap checklist Meet with your Medical Director and review the

upcoming changes; keep them informed Meet and discuss the changes with all your physicians

and inform them of changes they will have to make Practice interviews and ensure all team members receive

training and also practice Practice Section B0700 for determining the interviewable Initiate care plans based on the information derived from

those interviews

The Race to the MDS 3.0

• Roadmap checklist Utilize the BIMS and begin to care plan based on the

information obtained Determine in advance what documentation practices need

updated, what tools to use such as tracker forms – be ready to go

Education

THE NINE DAY COUNTDOWN Assess – Plan – Implement- Celebrate

Countdown Orchestrate the Change

Select a TEAM if you haven’t done so NHA and DON must be an active part of the team Determine your immediate transition needs Delineate assignments Make it a written plan – so little time left Communicate daily Be willing to “change” Celebrate each success

Countdown Provide the Team with current MDS 3.0 training materials

Obtain the most recent MDS 3.0 Training Materials from the CMS website

CMS Home > Medicare > Nursing Home Quality Initiatives >MDS 3.0 Training Materials https://www.cms.gov/NursingHomeQualityInits/45_NHQIMDS30TrainingMaterial.asp

September 3rd updates available Includes Instructor Guides, Training slides, RAI Chapters and Sections CMS new naming convention for the RAI manual. Updated sections

and chapters will have version numbers / dates MDS 3.0 Chapter 4 V1.03 August 2010 changing with an update to

V1.04, V1.05, etc

Countdown Maintaining Assessments - Federal Regulation

RAI MDS 3.0 Manual, Chapter 2, page 2-5 Storage space is a critical issue “to maintain all resident assessments completed within the previous

15 months in the resident’s active clinical record” “regardless of the form of storage, (electronic or hard copy)” “The 15-month period for maintaining assessment data may not

restart with each readmission to the facility:”• Discharge return anticipated & returns within 30 days• Discharge return not anticipated – facility policy • Demographic information Items A0500-A1600 must be

maintained in the clinical record

Countdown Electronic signatures permitted for the MDS

RAI Manual MDS 3.0, Chapter 2, page 2-6

Use of electronic signatures for the MDS does not mean your entire medical record must be electronic

Written policies to ensure proper security measures to protect the use of an E-signature

Electronic MDS and no E-signatures hard copies of signed and dated CAA’s (V0200B) correction completion (Items X1100A-E), and assessment completion items (Items Z0400 to Z0500) in the active record

Countdown Therapy

Major reimbursement change in therapy coding Section O RAI Manual Chapter 3, Section O, O-12 through O-26 Therapy codes – individual, concurrent and group

Individual – one therapist to one resident at a time Concurrent – two residents at same time / two different activities

and both are in line sight of the therapist Group – 2 to 4 residents who may or may not be doing the same

therapy activity Section T the predictor is gone Short stay = discharge by Day 8 has special RUG groupers SOT = start of therapy OMRA OMRA = stop of therapy OMRA = Start and stop of therapy OMRA

Countdown Resident Scripted Interviews Systematic / Privacy / Confidentiality

Section C - Cognitive status BIMS RAI Manual Chapter 3, C-1 through C-15

Section D – Mood PHQ-9 RAI Manual Chapter 3, D-1 through D-9

Section F – Preferences for Customary Routine and Activities RAI Manual Chapter 3, F-1 through F - 13

Section J – Health Conditions (pain) RAI Manual Chapter 3, J-4 through J-14

Countdown Resident / Family Informational Meetings

Share the actual resident interview questions Share the interview questions that families can participate in Share and discuss Section Q Return to the Community

“Do you want to talk to someone about the possibility of returning to the community”

Countdown CMS Transition Plan for your Medicare Part A residents • Transition is all about PPS – Medicare Part A stay• Transition does NOT apply to OBRA • Transition applies to SEPTEMBER AND OCTOBER

– MDS 2.0 FOR SEPTEMBER AND MDS 3.0 FOR OCTOBER – For Part A stays beginning prior to Sept 30th that continue into

October • Presumption of Coverage continues • ARD payment schedules the same • Default payment will remain in effect • Has 52 upper RUG groups • During the transition the ARD’s are SET ! • Grace days are NOT to be used until December

Countdown CMS Transition Plan for your Medicare Part A residents

• Providers must complete all OBRA required assessments according to

OBRA schedule

• The transition does not apply

– When payment ends 09-30-10 or sooner

– SNF PPS payment for assessment ends 9-30-10

– When payment begins 10-01-10 or later

– Medicare care stay begins 10-01-10 or later

– SNF PPS payment for assessment begins 10-01-10

Countdown CMS Transition Plan for your Medicare Part A residents Default Option: When a resident’s Part A stay ends 10-1 to 10-4, you may “opt

for default payment” by not completing the applicable MDS 3.0 PPS assessment (for the October payment days)

Option #1 “no substitution” • May opt to complete MDS 2.0 and MDS 3.0 same type, to cover a single payment period • MDS 2.0 in Sept. and MDS 3.0 in Oct. • All covered days will have a RUG • Safest but may be the most time consuming • If resident remains skilled after that payment period, you would then complete the next required MDS 3.0

Countdown CMS Transition Plan for your Medicare Part A residents Option #2 “substitute the MDS 3.0 for MDS 3.0”

Similar to #1 in that you would complete an MDS 2.0 Unlike #1 in that you do not complete the same-type of MDS 3.0 but

you do the next one MDS 2.0 covers RUG-III in Sept. and MDS 3.0 covers applicable Oct.

RUG-IV payment days RISKY – you are ‘skipping’ a MDS 3.0 of the same

Countdown CMS Transition Plan for your Medicare Part A residents Option #3 “substitute the MDS 3.0 for MDS 2.0” May opt to “substitute” MDS 3.0 for same type MDS 2.0 You will not complete an MDS 2.0 for payment that spans both Sept.

and Oct. You are completing the required MDS 3.0 for that payment period The MDS 3.0 will generate RUG-III to pay for days in Sept. and a RUG-IV

to pay for days in October If resident remains skilled – complete the subsequent MDS 3.0 to cover remaining Oct. days • Carries the Risks of both Option #1 and #2

Countdown Return to the Community Section Q RAI Manual Chapter 3, Section Q-1 through Q-16

Resident asked directly about whether they would like to speak to someone about the possibility of returning to the community

Yes response – Local Contact Agency SNF has 10 business days to make contact the LCA!

3 days by phone; and within 10 days for on-site visit if needed Provide timely information about their choices, services, etc Collaborate with the NF to organize the transition

October 1, 2010 Evaluate and Re-energize

Follow-up to ensure that the new systems continue to operate correctly

Be prepared for failures or setbacks in your systems and ensure the team jumps right back in and makes necessary revisions

Ask line staff how involved they feel in the overall facility plan When possible use technology to communicate, to share documents

and information with team members on other shifts or days Identify all the successes – BIG and small Celebrate

Future Challenges I-Centered Care Plans

Learning curve – CAT’s, CAA’s and Care planning Best practices and industry standards

Survey Process Pre QI-QM resident selection Survey outcomes

Quality Indicators – Quality Measures Risk Identification High level data / benchmark

Reimbursement – Medicare and Medicaid RUG-IV learning curve Hybrid RUG-IV challenges PA Case Mix new challenges

Future Challenges

Continuous education Changes Additional education Staff retention and training needs

Affinity Health Services, Inc. Senior Community Management and Consulting Services

Indiana, PA Toll Free (877) 311-0110 mstoup@affinityhealthservices.net

Due to the frequent and subsequent changes to the RAI MDS 3.0 manual and regular CMS updates, the information contained in this presentation should only be considered current as of the date of the presentation. Each participant is responsible for the most current information from CMS. 09.22.10