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CHANGE IS COMING MDS 3.0. LORI COSTA REGULATORY AND CLINICAL CONSULTANT AGING SERVICES OF CALIFORNIA APRIL 2010. INTRODUCTION. “PERFECT DOESN’T EXIST, CHANGE IS GOOD” SEMINAR SCHEDULE AGENDA FOR TODAY. IN THE BEGINNING. CONTRACT WITH HARVARD UNIVERSITY AND RAND CORPORATION

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change is coming mds 3 0

CHANGE IS COMINGMDS 3.0

LORI COSTA

REGULATORY AND CLINICAL CONSULTANT

AGING SERVICES OF CALIFORNIA

APRIL 2010

introduction
INTRODUCTION
  • “PERFECT DOESN’T EXIST, CHANGE IS GOOD”
  • SEMINAR SCHEDULE
  • AGENDA FOR TODAY
in the beginning
IN THE BEGINNING
  • 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 beginning4
IN THE BEGINNING
  • FINAL REPORT – DEVELOPMENT & VALIDATION OF A REVISED NURSING HOME ASSESSMENT TOOL; MDS 3.0
  • http://www.cms.gov/NursingHomeQualityInits/25_NHQIMDS30.asp
mds 3 0 goals
MDS 3.0 GOALS
  • ADVANCES IN ASSESSMENT MEASURES
  • INCREASE CLINICAL RELEVANCE OF ITEMS
  • IMPROVE THE ACCURACY AND VALIDITY OF THE TOOLS
  • INCREASE THE RESIDENTS VOICE
mds 3 0 goals6
MDS 3.0 GOALS
  • IMPROVE THE TOOL’S CLINICAL UTILITY AND ACCURACY
  • MAINTAIN ABILITY TO USE DATA FOR QUALITY INDICATORS, QUALITY MEASUSRES AND PAYMENT
methods
METHODS
  • INTERACTIVE PROCESS FOR CONSTANT INPUT
  • VALIDATION AND EVALUATION
    • 71 COMMUNITY NURSING HOMES
    • 19 VA NURSING HOMES
key findings
KEY FINDINGS
  • IMPROVED RESIDENT INPUT
  • IMPROVED ACCURACY AND RELIABILITY
  • IMPROVED EFFICIENCY
  • IMPROVED STAFF SATISFACTION AND PERCEPTION OF CLINICAL UTILITY
policy
POLICY
  • MEDICARE AND MEDICAID CERTIFIED FACILITIES
  • ASSESSMENT, QUALITY MEASURES AND MEDICARE PAYMENT
  • STATE DATA COLLECTION
cms changes
CMS CHANGES
  • 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 changes11
CMS CHANGES
  • N – ADDED FOUR ITEMS
  • O – ADDED COLUMNS AND ITEMS
  • Q – SOME CHANGES
important dates
IMPORTANT DATES
  • 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 dates13
IMPORTANT DATES
  • 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 dates14
IMPORTANT DATES
  • APPENDIX P REVISION JUNE 2010
overview of changes
OVERVIEW OF CHANGES
  • RAI SYSTEM
  • MDS MANUAL
  • ASSESSMENT FORMS
rai system
RAI SYSTEM
  • 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 system17
RAI SYSTEM
  • 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 system18
RAI SYSTEM
  • QUARTERLY – NOT ALL ITEMS ARE ACTIVE
  • SECTION Z ADMINISTRATION OF ASSESSMENTS AND ATTESTATIONS
  • UPDATES WILL CONTINUE
manual
MANUAL
  • 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
manual20
MANUAL
  • V – SUBMISSION AND CORRECTION OF ASSESSMENTS
  • VI – SNF PPS
  • APPENDICES
appendices
APPENDICES
  • GLOSSARY AND COMMONS ACRONYMS
  • STATE AGENCY AND CMS REGIONAL OFFICE CONTACTS
  • CARE AREA ASSESSMENT RESOURCE
  • INTERVIEWING TECHNIQUES
appendices22
APPENDICES
  • COGNITIVE PERFORMANCE SCORING RULES
  • MDS DRAFT MATRIX
  • REFERENCES
  • FORMS
assessment form
ASSESSMENT FORM
  • SIGNIFICANT VS. MINOR CHANGES
  • MORE INSTRUCTIONS
  • CLEARER GUIDANCE FOR CODING
  • LOOK BACK PERIODS CHANGED
  • LOOK BACK PERIOD SHORTENED IN MOST PLACES
assessment form24
ASSESSMENT FORM
  • MORE FORMS
  • INTERVIEW ITEMS
  • SCRIPTED TESTS
  • SKIP PATTERNS
  • CHANGE IN RESPONSE CHOICES
  • OPTIONAL ITEMS
  • LARGER FONTS
assessment form25
ASSESSMENT FORM
  • COMBINED RESPONSE CATEGORIES
  • LOGICAL GROUPING AND PAGE BREAKS
  • CONSISTENT PATTERNS FOR RESPONSE TYPES
  • SEPARATION OF MULTIPLE ITEMS
  • DEFINITIONS ON FORM
assessment form26
ASSESSMENT FORM
  • 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 form27
ASSESSMENT FORM
  • MISSING
    • FECAL IMPACTION
    • MODES OF EXPRESSION
    • LAB TESTS
    • INFECTIONS
    • ADVANCE DIRECTIVES
    • FLUID BALANCE
    • WEIGHT GAIN
skip patterns
SKIP PATTERNS
  • IN ASSESSMENT SECTIONS AS WELL AS IN ITEM CODING
  • MORE PREVALENT IN INTERVIEW SECTIONS
  • SECTIONS WITH SKIP PATTERNS
    • A, B, C, D, E, F, H, J, K, M, N, O, Q
no skip patterns
NO SKIP PATTERNS
  • SECTIONS WITH NO SKIP PATTERNS G, L AND P
  • DON’T SKIP MANDATED DATA IN SKIP PATTERN SECTIONS
new tests
NEW TESTS
  • BIMS – COGNITIVE ASSESSMENT
  • PHQ-9 – MOOD ASSESSMENT
  • PHQ-9OV MOOD ASSESSMENT
  • CAM – MENTAL STATUS
interviews
INTERVIEWS
  • C – COGNITIVE PATTERNS
  • D – MOOD
  • F – PREFERENCES FOR CUSTOMARY ROUTINE AND ACTIVITIES
  • J – HEALTH CONDITIONS
  • Q – RETURN TO COMMUNITY
  • G – ADL – RESIDENT QUESTION
slide32
EXAM
  • ORAL AND DENTAL
  • BALANCE TEST
section s
SECTION S
  • CALIFORNIA LISTED AS COLLECTING POLST DATA
  • NO LEGISLATION
  • NO MANUAL INSTRUCTIONS
  • CDPH SAYS AT THIS TIME IT IS VOLUNTARY
what nurses found
WHAT NURSES FOUND
  • 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 found35
WHAT NURSES FOUND
  • 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 found36
WHAT NURSES FOUND
  • FOUND SIGNIFICANT RESIDENT FINDINGS
  • ONCE LEARNING CURVE DECREASES TIME WAS MUCH LESS
what you need to do now
WHAT YOU NEED TO DO NOW !!!!!
  • 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 now38
WHAT YOU NEED TO DO NOW !!!
  • 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 now39
WHAT YOU NEED TO DO NOW !!!
  • BUDGET THE RESOURCES THAT YOU WILL NEED-STAFF,EQUIPMENT ETC.
  • CHANGE THE NECESSARY POLICIES, PROCEDURES AND SYSTEMS
  • EDUCATE YOUR PHYSICIANS
  • RESIDENT ORIENTATION
the future
THE FUTURE
  • IF YOU DON’T CHANGE THE CULTURE OF THE NURSING HOME WHO WILL?
  • MDS 3.0 IS CULTURE CHANGE IN ACTION.
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