CHANGE IS COMING
MDS 3.0
LORI COSTA
REGULATORY AND CLINICAL CONSULTANT
AGING SERVICES OF CALIFORNIA
APRIL 2010
INTRODUCTION
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“PERFECT DOESN’T EXIST, CHANGE IS
GOOD”
SEMINAR SCHEDULE
AGENDA FOR TODAY
IN THE BEGINNING
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CONTRACT WITH HARVARD
UNIVERSITY AND RAND CORPORATION
RESPONSIVE TO CHANGES TO
NURSING HOME CARE, RESIDENT
CHARACTERISTICS, ASSESSMENT
METHODS, AND PROVIDER AND
CONSUMER CONCERNS ABOUT MDS
2.0 PERFORMANCE
IN THE BEGINNING
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FINAL REPORT – DEVELOPMENT &
VALIDATION OF A REVISED NURSING
HOME ASSESSMENT TOOL; MDS 3.0
http://www.cms.gov/NursingHomeQuali
tyInits/25_NHQIMDS30.asp
MDS 3.0 GOALS
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ADVANCES IN ASSESSMENT MEASURES
INCREASE CLINICAL RELEVANCE OF
ITEMS
IMPROVE THE ACCURACY AND
VALIDITY OF THE TOOLS
INCREASE THE RESIDENTS VOICE
MDS 3.0 GOALS
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IMPROVE THE TOOL’S CLINICAL
UTILITY AND ACCURACY
MAINTAIN ABILITY TO USE DATA FOR
QUALITY INDICATORS, QUALITY
MEASUSRES AND PAYMENT
METHODS
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INTERACTIVE PROCESS FOR
CONSTANT INPUT
VALIDATION AND EVALUATION
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71 COMMUNITY NURSING HOMES
19 VA NURSING HOMES
KEY FINDINGS
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IMPROVED RESIDENT INPUT
IMPROVED ACCURACY AND
RELIABILITY
IMPROVED EFFICIENCY
IMPROVED STAFF SATISFACTION AND
PERCEPTION OF CLINICAL UTILITY
POLICY
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MEDICARE AND MEDICAID CERTIFIED
FACILITIES
ASSESSMENT, QUALITY MEASURES
AND MEDICARE PAYMENT
STATE DATA COLLECTION
CMS CHANGES
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D – ADDED TWO ITEMS
F – REMOVED FOUR ITEMS
G – REMOVED ITEMS
I – ADDED EIGHT ITEMS
J – REMOVED 2 AND ADDED 3 ITEMS
M – ADDED RISK ITEMS, ADDED FOUR
ITEMS AND REMOVED ONE, ASKED
FOR DATE INFORMATIONS
CMS CHANGES
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N – ADDED FOUR ITEMS
O – ADDED COLUMNS AND ITEMS
Q – SOME CHANGES
IMPORTANT DATES
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UPDATED MANUAL AND FORM MAY OR
JUNE 2010
NEW QUALITY MEASURES ON
NURSING HOME COMPARE APRIL OR
MAY 2012
TRAINING MATERIALS ON CMS
WEBSITE JUNE 2010
IMPORTANT DATES
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RUGS TRAINING SUMMER S010
RUGS IV IMPLEMENTATION OCTOBER
2011 – COLLECTION BEGINS OCTOBER
2010
RUGS IV UPDATED DECEMBER 2010
FIRST TRIGGER UPDATES & OTHERS
JANUARY 2011
IMPORTANT DATES
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APPENDIX P REVISION JUNE 2010
OVERVIEW OF
CHANGES
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RAI SYSTEM
MDS MANUAL
ASSESSMENT FORMS
RAI SYSTEM
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THE RAI SYSTEM IS NOT THE ENTIRE
STANDARD OF PRACTICE FOR
RESIDENT ASSESSMENT
QUESTION OF WHO CAN ASSESS
KEEPS COMING UP
ADDS NEW ASSESSMENTS
RAI SYSTEM
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CHANGES TIMELINES
DATA WILL GO DIRECTLY TO CMS
REPOSITORY
WILL BE ABLE TO PRINT OUT SOME
CLARIFYING REPORTS FROM CASPER
SOME ITEMS WILL BE SELF
POPULATED
RAI SYSTEM
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QUARTERLY – NOT ALL ITEMS ARE
ACTIVE
SECTION Z ADMINISTRATION OF
ASSESSMENTS AND ATTESTATIONS
UPDATES WILL CONTINUE
MANUAL
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I – INTRODUCTION
II – INSTRUCTIONS AND SCHEDULE
FOR COMPLETING ASSESSMENTS
III – ITEM-BY-ITEM GUIDE TO MDS 3.0
IV – CARE AREA ASSESSMENT (CAA)
PROCESS AND CARE PLANNING
V – SUBMISSION AND CORRECTION OF
ASSESSMENTS
MANUAL
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V – SUBMISSION AND CORRECTION OF
ASSESSMENTS
VI – SNF PPS
APPENDICES
APPENDICES
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GLOSSARY AND COMMONS ACRONYMS
STATE AGENCY AND CMS REGIONAL
OFFICE CONTACTS
CARE AREA ASSESSMENT RESOURCE
INTERVIEWING TECHNIQUES
APPENDICES
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COGNITIVE PERFORMANCE SCORING
RULES
MDS DRAFT MATRIX
REFERENCES
FORMS
ASSESSMENT FORM
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SIGNIFICANT VS. MINOR CHANGES
MORE INSTRUCTIONS
CLEARER GUIDANCE FOR CODING
LOOK BACK PERIODS CHANGED
LOOK BACK PERIOD SHORTENED IN
MOST PLACES
ASSESSMENT FORM
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MORE FORMS
INTERVIEW ITEMS
SCRIPTED TESTS
SKIP PATTERNS
CHANGE IN RESPONSE CHOICES
OPTIONAL ITEMS
LARGER FONTS
ASSESSMENT FORM
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COMBINED RESPONSE CATEGORIES
LOGICAL GROUPING AND PAGE
BREAKS
CONSISTENT PATTERNS FOR
RESPONSE TYPES
SEPARATION OF MULTIPLE ITEMS
DEFINITIONS ON FORM
ASSESSMENT FORM
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DELETION OF POORLY PERFORMING
ITEMS
CONSOLIDATION OF ITEMS
ENTRY AND DISCHARGE DATA
PASRR INFORMATION IN SECTION A
ITEMS MAY ASK FOR NUMBER OF DAYS
OR TIMES
ASSESSMENT FORM
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MISSING
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FECAL IMPACTION
MODES OF EXPRESSION
LAB TESTS
INFECTIONS
ADVANCE DIRECTIVES
FLUID BALANCE
WEIGHT GAIN
SKIP PATTERNS
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IN ASSESSMENT SECTIONS AS WELL
AS IN ITEM CODING
MORE PREVALENT IN INTERVIEW
SECTIONS
SECTIONS WITH SKIP PATTERNS
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A, B, C, D, E, F, H, J, K, M, N, O, Q
NO SKIP PATTERNS
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SECTIONS WITH NO SKIP PATTERNS
G, L AND P
DON’T SKIP MANDATED DATA IN
SKIP PATTERN SECTIONS
NEW TESTS
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BIMS – COGNITIVE ASSESSMENT
PHQ-9 – MOOD ASSESSMENT
PHQ-9OV MOOD ASSESSMENT
CAM – MENTAL STATUS
INTERVIEWS
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C – COGNITIVE PATTERNS
D – MOOD
F – PREFERENCES FOR CUSTOMARY
ROUTINE AND ACTIVITIES
J – HEALTH CONDITIONS
Q – RETURN TO COMMUNITY
G – ADL – RESIDENT QUESTION
EXAM
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ORAL AND DENTAL
BALANCE TEST
SECTION S
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CALIFORNIA LISTED AS COLLECTING
POLST DATA
NO LEGISLATION
NO MANUAL INSTRUCTIONS
CDPH SAYS AT THIS TIME IT IS
VOLUNTARY
WHAT NURSES FOUND
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THE CHANGE IS NOT MEDS 2.0 TO 3.0.
THE CHANGE IS THE OLD YOU TO THE
NEW YOU
DOCUMENT TAKES NURSES BACK TO
RESIDENT CENTERED CARE
PAPER CARE TO RESIDENT CARE
NURSES GATHERED INO THE FACILITY
NURSES DIDN’T KNOW
WHAT NURSES FOUND
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RESIDENTS SAID NO ONE ASKES ME
WHAT I WANT, THEY JUST TELL ME
WHAT TO DO
FACILITY NURSES KEPT SAYING
RESIDENTS NON INTERVIEWABLE –
NURSE ASSESSORS FOUND
OTHERWISE
WHAT NURSES FOUND
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FOUND SIGNIFICANT RESIDENT
FINDINGS
ONCE LEARNING CURVE DECREASES
TIME WAS MUCH LESS
WHAT YOU NEED TO DO
NOW !!!!!
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DO ANALYSIS OF CURRENT SYSTEM
HAVE A PLANNED & COORDINATED
APPROACH
INVOLVE YOUR CONTRACTED SERVICES,
CONSULTANTS, SOFTWARE VENDOR
DECIDE WHO IS GOING TO DO WHAT
PRACTICE INTERVIEWS
GET FAMILIAR WITH TEST QUESTIONS
WHAT YOU NEED TO DO
NOW !!!
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PLAN AND START INSERVICE
PROGRAMS
CONSIDER CULTURAL AND LANGUAGE
BARRIERS
DEVELOP TOOLS – REMEMBER WE ARE
OUR OWN WORST PAPER ENEMY
FIND PRIVATE PLACE FOR
INTERVIEWS
WHAT YOU NEED TO DO
NOW !!!
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BUDGET THE RESOURCES THAT YOU
WILL NEED-STAFF,EQUIPMENT ETC.
CHANGE THE NECESSARY POLICIES,
PROCEDURES AND SYSTEMS
EDUCATE YOUR PHYSICIANS
RESIDENT ORIENTATION
THE FUTURE
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IF YOU DON’T CHANGE THE CULTURE
OF THE NURSING HOME WHO WILL?
MDS 3.0 IS CULTURE CHANGE IN
ACTION.