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Paired Assessment Accuracy Report. Paired Assessment Accuracy Report (PAAR). Purpose to provide nursing facilities with information regarding potential MDS coding discrepancies Intent to be a tool for provider self-audit Vision for the future first generation of provider feedback reports.
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Paired Assessment Accuracy Report (PAAR) • Purpose • to provide nursing facilities with information regarding potential MDS coding discrepancies • Intent • to be a tool for provider self-audit • Vision for the future • first generation of provider feedback reports
What is the PAAR? • A report generated from the MDS national repository that evaluates pairs of sequential MDS assessments • 5 and 14 day • 90 and 90 day • Intended to capture “potential” MDS coding errors • assessments that do not change when the clinical condition of interest would be expected to have changed between the two assessments • pneumonia at 14 days, bladder continence in cognitively impaired residents at 180 days
Example: Pneumonia • MDS Item I2e • Coded “yes” on both the 5 day and 14 day assessments • Clinical rationale for this trigger • pneumonia that persists at Day 14 for a resident who was admitted with pneumonia is oftentimes resolved by 14 days because it was treated in the hospital for several days prior to facility admission • facilities that have a very large number of residents with pneumonia that persists between 5 days and 14 days may have a problem with MDS coding of this item
Example: Bladder Continence • MDS Item H1b • Coded “continent” on two sequential quarterly (90 day) assessments • Risk adjusted for those residents who are cognitively impaired • Clinical rationale for this trigger • Long-stay, cognitively impaired residents are at great risk for bladder incontinence • Facilities with high numbers of MDS assessments indicating continence on sequential quarterly assessments may have a problem with MDS coding of this item
Sample PAAR Pneumonia Trigger Page Pneumonia Trigger (MDS Element I2e) Total Residents with 5- and 14- day assessments: 212 Residents triggering: 8 Percent at this facility: 3.7 % Compare with: 8.2% nationally 9.4% State of State Definition of I2e Pneumonia: Inflammation of the lungs; most commonly of bacterial or viral origin. Importance of Pneumonia as an MDS Accuracy Trigger: Symptoms of active pneumonia may include elevated respiratory rate, cough, shortness of breath, chest pain, abnormal breath sounds, and impaired ADL or cognitive functioning. Although pneumonia symptoms may persist in a newly admitted facility patient and be coded on the 5-day assessment, it is unlikely that with treatment the pneumonia would still be active on the 14-day MDS assessment. A pattern showing a large number of cases where pneumonia is coded on both the 5-day and 14-day MDS may be indicative of a coding error.
Resident Name Medicare HIC DOB 5-day A3a Date 14-day A3a Date 5-day I2e value 14-day I2e value JOHN EVANS 999999999A 11/09/1922 06/06/2002 6/13/2002 1 1 ERICA NEWCOME 999999999A 01/11/1915 01/03/2002 01/12/2002 0 1 Sample PAAR, cont.
How does the PAAR work? • Reports made available through CASPER on-line reports • Provider expected to • Review report • Select cases for review • Review the documentation in the medical record for each of the MDS pairs to determine if MDS coding is correct • Submit corrected MDS forms as needed • Use knowledge gained from the process to improve facility coding practices
PAAR Feasibility Tests • Focus Group • Six participants • Nominated by AHCA, AAHSA, and AANAC • Credentials: involved in day-to-day MDS assessment activities • Reviewed and provided feedback on early versions of reports and manuals
PAAR Feasibility Tests, cont. • Pilot Project • 31 facility volunteers participated • AR, IN, NH, VT, VA • Results • Reports easily accessed • PAAR process aided facilities in improving their understanding of correct MDS coding criteria
What can providers expect with regard to Feedback Reports? • National PAAR Release • Fall 2003 • Access to reports via QIES • Expectation that reports will be used by providers for self-audit • On-going development and dissemination of other MDS accuracy feedback reports • Eventual requirement that some action is taken by provider upon receipt of PAAR (or other feedback report)
