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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
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
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
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
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
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.

sample paar cont

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
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
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
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
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)