The Scoop on MDS 3.0
Edition: October 2010 - Vol 18 Number 10
Just when your long-term-care customers’ patient assessment programs were (almost) running like clockwork, the rules have changed. Presumably, nursing home and long-term-care administrators and staff have done their homework this past year and are now on board with Minimum Data Set (MDS) 3.0. But, unless distributor reps also have a thorough understanding of the new rules, they will not be in a position to offer the best solutions and services.
What is MDS?
The Minimum Data Set, or MDS, is a standardized primary screening and assessment tool for assessing the physical, psychological and psychosocial functional capacity of residents at Medicare- and/or Medicaid-certified long-term-care facilities. In 1997, the Centers for Medicare and Medicaid Services (CMS) published the rule establishing the guidelines for using the MDS, and long-term-care facilities must complete and transmit MDS data to the designated state agency in order to participate in the Medicare or Medicaid reimbursement program.
For years, long-term-care administrators, nurses and other staff have followed MDS 2.0 guidelines, working to keep abreast of any changes or updates. With the formal transition to MDS 3.0 as of Oct. 1, 2010, they must be on board with perhaps the most sweeping changes yet. In many cases, MDS 3.0 demands that administrators provide more detailed information about residents, sometimes within a shortened timeframe. In addition, MDS 3.0 emphasizes an interdisciplinary approach more so than MDS 2.0. This means clinicians and staff in every department, from nursing to Medicare billing to administration, must know their patients and communicate with one another to create the most accurate patient assessment record to date.
Stepping out with 3.0
In a nutshell, MDS 3.0 calls for more extensive staff-, clinician- and administrative-directed interviews with residents with, in some cases, less time to conduct them, according to Donna Adendorff, director of assessment services, Turenne & Associates (Montgomery, Ala.). “Some of the timeframes have been cut in half, from 30 or 31 days to about two weeks,” she points out.
Further, while the process has always been intended to be interdisciplinary, this approach has become even more central to accurate transmission of MDS and the contingent reimbursement. “The whole point of MDS 3.0 is to accurately capture the resident profile,” she says. “To achieve that accuracy, you need an interdisciplinary approach [that involves] the wound care department, therapists, dieticians, social workers, nurses, restorative practitioners, Medicare billing specialists, business office managers, activities directors and administrators,” she explains. “Facilities that already have an interdisciplinary approach, as well as those that have full or partial electronic record-keeping will have a leg up on MDS 3.0.”
Finally, CMS is revising its quality indicators for MDS 3.0. “The new quality indicators won’t be up and running until later next year,” says Adendorff. This will make it tricky in the early months for long-term-care facilities to navigate MDS 3.0, she adds.
Adendorff highlights the following changes entailed in the move from MDS 2.0 to MDS 3.0:
• Many sections of MDS have been renamed (e.g., Section M in MDS 3.0 is not necessarily the same as Section M in MDS 2.0)
• Section C (Cognitive Patterns) now includes a Brief Interview for Mental Status (BIMS).
• Section D (Mood) now includes an interview to assess depression (PHQ-9).
• Section E (Behaviors) has been expanded such that facilities now must assess whether a resident’s behavior impacts him/herself or other residents.
• Section F (Preferences for Customary Routine and Activity) has been expanded and now addresses each resident’s quality of life, including how important it is for him/her to participate in different activities, as well as how the facility can incorporate these activities into his/her life. This section covers about 16 different areas, from choosing one’s outfit to wear each day, to snacks and meals, personal hygiene, interests, social activities, religious interests and more.
• Section J (Health Conditions) has been expanded and now includes a more detailed interview of residents, focusing on how pain affects their function. Regarding patient falls, facilities now must report the number of falls and type of injury associated with each fall.
• Section M (Skin Conditions) is more comprehensive and has been expanded to include deep tissue injury.
• Section O (Special Treatments and Procedures) now requires facilities to delineate which treatments and procedures are provided to patients while they are a resident at the facility and while not a resident at the facility.
• Section Q (Participation in Assessment and Goal Setting) has been expanded significantly, such that facilities must interview residents prior to their discharge about their return to the community. Depending on a resident’s response, the facility may have to contact appropriate agencies to assist them. (This section is still under development, according to Adendorff.)
Other changes reflected in MDS 3.0 include:
• Section G (Functional Status) now requires facilities to assess each resident’s balance during transition/walking/activities, with an increased risk for falling.
• Section H (Bowel and Bladder) no longer rates catheter and ostomy as “continent” and fecal impaction has been eliminated from the QI/QM.
• Section I (Diagnosis) now includes diagnosis identification reflected in the past 30 days. Once the diagnosis is made, facilities must determine whether or not the condition is active.
• Section K (Swallowing and Nutritional Status) looks more closely at weight loss (e.g. Has a weight loss program been prescribed by a physician?).
Of particular concern for long-term-care facilities is their response to the changes called for by MDS 3.0, which can impact how they are reimbursed, notes Adendorff. “We should expect to see a learning curve with regard to the actual coding,” she says. “It could take more than a year to work out how [MDS 3.0] will continue to evolve and our understanding of that.”