Long-term care professionals are using a variety of approaches to streamline work within the MDS 3.0 assessment process implemented last October. Some of these approaches have indeed been positive as interdisciplinary teams adapt to such significant change. Through my consultative work I have assisted facilities in developing policies and processes to improve compliance and increase efficiency while working with this new payment system. Sharing the structure of these approaches will help others deal with the changes and demands of the updated process. In particular, this article will detail the operational approach to MDS 3.0. Before we examine it, however, heed this reminder: Changes to the MDS and the RUG payment process are significant for all levels of operational and clinical management. Greater staff involvement is necessary.
INVOLVING THE HIGHER-UPS
Providing specific operational training on the MDS 3.0 assessment to senior management teams has proven to be successful with many ownership groups. This approach allows senior management to understand the size and implication of the new data set and its impact on the regulatory and payment process. Many managers are used to sending their MDS nurses to training and then expect them to manage the process. That outdated method does not work with these changes because the new process impacts many departments and the potential for payment loss and/or regulatory risk is much higher.
MDS nurses and members of the interdisciplinary teams who code sections or items of the MDS must have proper resources and training on the 3.0 process. And it needs to be specific to the time.
It is also important that the person managing the MDS assessment process is allowed to communicate with facility administration so interdisciplinary participation and performance is defined and monitored. Teams that have instituted this change are finding it to be positive. Along with this protocol the actual assessment activity in facilities is now identified and reviewed weekly with operational teams. This includes the number of assessments by type and confirmation of validation. MDS managers should meet with administrators weekly to discuss assessment issues and activity. In facilities that have implemented this practice, process efficiency as well as team accountability has improved dramatically. Senior managers are free to track issues with software performance and increase communication to their vendors. Remember, all facilities have new software that requires training and adjustments in the MDS office. First, managers and MDS staffs need to have training on the process and then manage the assessment process operationally to ensure compliance and lower risk. The MDS 3.0 is not just a different assessment format; it is a refreshed process with many new definitions, timelines, and requirements that creates a very specific and detailed database of facilities' services, demographics, and outcomes.
ATTEND TO THE WORK SPACE
As a consultant I like to make a thorough assessment of the MDS office. This is the hub of data communication for interdisciplinary teams but also the location of data input into the systems that transmit assessment documents for validation. The office's location must provide an efficient work environment, promote communication within the operational and clinical teams, and be conducive to data entry and record review. There must be adequate software and hardware to correlate and transmit resident data. MDS 3.0 has shortened the timelines for completion and transmission of the data sets as well as required additional lengthy assessments for discharge and reentry. This dramatically increases the number of assessments MDS nurses must do.
Assess the MDS office for efficiency and see that there is adequate work space and resources for nurses to complete these tasks. For instance, some high-acuity facilities have introduced double screens for MDS nurses working on high volumes of assessments. This allows two files to be open at once. Hardware capacity must also be evaluated to prevent downtime.
CLEAN UP THE CODING
Another common issue is the challenge of getting accurate coding of ADL performance from caregiving staff during the assessment reference period. We all understand the importance of the ADL score, but the decline of ADL values from the MDS 2.0 to 3.0 systems has not been widely discussed.
Frontline ADL assistance for Bed Mobility, Transfer, Eating and Drinking, and Toilet Use must be coded from each shift during the assessment reference period. Most facilities have attempted this without success. Staff documentation habits can be improved by requiring that simple ADL trackers be completed during the assessment reference period during each shift. Scoring needs to be monitored by nursing or MDS staff with informal case-related training when needed to nurture this understanding. Large, formal in-service programs have not been as effective as one-on-one discussions, such as asking, “What did you do for Mr. Jones this shift?” and then translating the reply into correct coding.