MDS 3.0 –
Becoming a Reality
October 1, 2010
Presented to:
MDS 3.0 National Train the Trainer Conference
April 12-15, 2010
Baltimore, MD
Thomas Dudley, MS, RN
Centers for Medicare & Medicaid Services
Office of Clinical Standards and Quality
Quality Improvement and Health Assessment Group
Division of Chronic and Post Acute Care
• An updated version of the instrument
and manual will be published on the
MDS 3.0 page of www.cms.gov in late
May or early June.
• The taped version of this training
conference will be published on
www.cms.gov in late May or early June.
• Comments and questions can be
submitted to
MDS30Comments@cms.hhs.gov.
• The transition to MDS 3.0 is a TEAM
effort and together WE will successfully
make it through the change.
• Yes, the new MDS 3.0 instrument will be
challenging at first, but keep in mind that
MDS 2.0 was challenging at first. Change is
hard, but change is good!
• “Perfect” doesn’t exist, we strive for
perfection, but inevitably there will be
hiccups. We all need to be patient as we
work through the change together.
•
History of MDS
• Why the Change to MDS 3.0?
• MDS 3.0 Timeline
• MDS 3.0 Training – Now and Beyond
• Quality Measures and Public Reporting
•
Simple answer: Because the law says so
• Omnibus Budget Reconciliation Act of 1987 is the
• Statutory & Regulatory Basis for the RAI
To provide a comprehensive, accurate,
standardized, reproducible assessment of each
resident's functional capabilities
• To help staff identify health problems
•
• Balanced Budget Act (BBA) of 1997
•Established the Skilled Nursing Facility (SNF)
prospective payment system (PPS).
• October 1988 – Development of the RAI Began
(HCFA established contracts with RTI, the Hebrew
Rehabilitation Center for Aged, Brown University &
the University of Michigan)
• October 1990 – Effective date for the RAI
• April 1995 – MDS 2.0
• April 1995 – Present – Instrument has remained
relatively static
•
Care Planning - December 1990
• Survey and Certification - December 1990
• Payment/Electronic Submission - June 22,
1998
• Nursing Home Quality Initiative/Public
Reporting - November 2002 and the QIO
Scope of Work
To make CMS happy?
NO
To give NH providers something to do?
NO
To give surveyors something to do?
NO
To make sure providers are paid properly?
YES
To make sure NH Residents are receiving appropriate care?
ABSOLUTELY YES
To provide NH providers with a tool to assess the status of their Residents in
order to appropriately develop plans of care to optimize quality of life?
ABSOLUTELY YES
 Why not?
 MDS 2.0 is outdated
 MDS 2.0 isn’t consistent with current
clinical practices
 MDS 2.0 has limited value to NH’s
outside of it being a required
assessment
Timeline
March
2010
April
• QMs Submitted to NQF
• RAI Training
• National Train the Trainer Conference
2010
May
• Revised RAI Manual, Technical Specifications, and Educational Materials to be
Published
2010
Summer
2010
September
30, 2010
• Tentative – Additional training opportunities (e.g. Satellite Broadcasts)
• MDS 2.0 is sent to the land of retired assessment instruments.
October
1, 2010
December
2010
January
2011
April 2011
– Spring
2012
April/Ma
y 2012
• …and then there was MDS 3.0
• Anticipated NQF endorsement of NH measures mapped
to MDS 3.0
• Last MDS 2.0 QM update on NHC
• QM data and 5-Star data on NHC????
• New MDS 3.0 QM data published on NHC
 SNF/LTC ODF
www.cms.gov/OpenDoorForums/25_ODF_SNFLTC.asp
 MDS 3.0 Website
www.cms.gov/NursingHomeQualityInits/25_NHQIMDS30.asp
• Available ~May-June 2010
• To be available online 24/7, 365
days/year
• Exactly the same content that was
available at the National Train-the-Trainer
Conference
Will include Post Acute and Chronic Care Measures
New measures will replace existing measures (or at a
minimum modify the existing measures based on the
MDS 3.0 Instrument)
18 Candidate measures submitted to NQF
Ultimately the measures will be published on Nursing
Home Compare
MDS 2.0 Quality Measures Recommended for
Retirement/Replacement
PAC Chronic
Delirium
Mobility decline
Pressure ulcers (low
risk)
Bedfast
Potential
Replacement
Delirium (new PAC
measure)
X
X
X
X
‘Ambulation’ (PAC and
Chronic)
Summary Table of 18 Measures Submitted to NQF for Endorsement
PAC
Chronic
Five-Star
Item
Percent of Residents with Pain
X
X
X
Delirium (replacement measure)
X
X
Percent of Short-Stay Residents with Pressure
Ulcers That Are New or Have Not Improved
X
X
Percent of Residents Who Were Assessed and
Given Pneumococcal Vaccination
X
X
Summary Table of 18 Measures Submitted to NQF for Endorsement
PAC
Percent of Residents Who Were Assessed and
Given Influenza Vaccination
X
Five-Star
Chronic
Item
X
ADL decline (replacement measure)
X
X
Mobility decline (replacement w/ focus on
ambulation)
X
X
Percent of Long-Stay, High-Risk Residents
with Pressure Ulcers
X
X
Summary Table of 18 Measures Submitted to NQF for Endorsement
Chronic
Five-Star
Item
Percent of Long-Stay Residents Who Were
Physically Restrained
X
X
Percent of Long-Stay Residents Who
Have/Had a Catheter Inserted and Left in
Their Bladder
X
X
Percent of Long-Stay Residents with a
Urinary Tract Infection
X
X
PAC
Summary Table of 18 Measures Submitted to NQF for Endorsement
PAC
Chronic
Percent of Long-Stay, Low-Risk Residents Who
Lose Control of their Bowels or Bladder
X
Percent of Long-Stay Residents Who Lose Too
Much Weight
X
Percent of Long-Stay Residents Who Have
Become More Depressed or Anxious
X
Five-Star
Item
Yes, October 1, 2010 is the
implementation date.
•
• Yes, this applies to everyone.
• Yes, all of us will survive the
change to MDS 3.0.
•
Additional QMs
• Modifications to the MDS
instrument to keep pace with
changes in clinical practices
• MDS 4.0, Continuity Assessment
Record and Evaluation Instrument
(CARE), or EHRs?
General Comments or Suggestions can be
submitted to:
MDS30Comments@cms.hhs.gov
Or
Specific Questions can be submitted directly
to me:
thomas.dudley@cms.hhs.gov