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Planning, communication, fiscal preparation ensures smooth transition

August 1, 2010
by Leah Klusch
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The big news this summer and fall is the conversion of the Resident Assessment Instrument (RAI) process from the MDS 2.0 to the MDS 3.0 and the related operational and fiscal changes.

Many in the field have identified these changes as one of the largest operational changes since July of 1999 when electronic transmission and the Prospective Payment System began.

This is a significant change for all facilities as a new database is created from the new assessment document with many new definitions, data collection processes, and the introduction of “Resident Voice” with the inclusion of four specific resident interviews as well as numerous questions that require direct inquiry from the residents and staff.

Impact to daily operations

Facility managers, operational professionals, ownership, and corporate consultants need to approach these new tasks with an understanding of the size of the change as it impacts daily operations. The first task is to realize that the RAI process is an operational responsibility that must be managed with administrative leadership and problem solving as the new assessment document is prepared for transmission. Time lines for changes in software, forms and formats for documentation, assessment assignments, and training as well as fiscal planning for payment changes will all impact the entire operational platform and could have significant negative outcomes if not managed properly. Many new policies will need to be developed as well as current policies may need to be revised or changed because of new definitions and processes with the 3.0 assessment process.

First, all team members must understand that the RAI process is not clinical; it is a total functional assessment that creates the database for the facility's care planning, regulatory, and payment outcomes. It must be managed as such and not delegated as a clinical task. This change in the assessment also requires a budget for software changes, training and, for many facilities, additional hardware to process a larger, more complex database with shorter windows for transmission. These are all facility management decisions and must be timed carefully so compliance can be achieved by the Octo-ber 1 implementation date.

The person managing the assessment tasks in the facility must be accountable to the facility administrator and be competent to initiate, plan, collect, and coordinate the transmission of data, and meet the time lines and requirements in the process. Many of these formats and requirements have changed presenting the facility with the need for increased efficiency and accuracy. For example, the transmission time for completed documents for validation has been cut to 14 days from the date the assessment is complete or the care plan is completed on comprehensive assessments.

Interviews

Four new interviews have been introduced (Brief Interview for Mental Status, Mood Interview, Customary Routine and Activity Preferences, and Pain Interview) that require structured one-on-one contact with each resident every time an assessment is completed. Training needs to be complete and policies for the interviews need to be established as well as procedures for staff assessments and tracking if interviews cannot be completed. At the least this will require preparation for the staff, residents, and families as this process is going to change the way assessments are completed from this time forward.

By December 2010, all residents will have experienced the new interviews and data collection at least once or multiple times if they are in a Medicare Part A stay.

Facility managers must be aware of the components of the MDS 3.0 form that will change clinical documentation processes, create new outcome reporting for regulators and payers, as well as define services with new definitions. For example, the coding of therapy services into three types of minutes-individual, concurrent, and group-all with specific values as they contribute to the total therapy minutes. Improved standards of clinical documentation will result related to pressure ulcer identification and care, pain management, and measurement of functional performance and outcomes as well as determination of cognitive performance from a standard scale. This is all very positive but must be introduced into the operational platform with proper training and support so all members of the interdisciplinary team are prepared and work together to complete the assessment on time, accurately, and within the structure of the new manual instructions.

Key steps

So what are the key steps managers need to address?

The interdisciplinary team must meet with the administrator to discuss time lines and steps to prepare for the change. Start short weekly meetings now to set goals and report progress.

A budget for training and materials needs to be created-the team will need new manuals, new software, and specific training for different levels of coding and data collection tasks. Start now. Some team members will need multiple training experiences because of the size and impact of the new assessment tasks, definitions, and formats for data collection. Online training after the implementation of the new process will support the knowledge base of current staff and train new staff members so the quality of the assessment process does not deteriorate and will provide a practical solution for ongoing training.

Current MDS activity needs to be identified so software and hardware needs can be established. This is a more complex database. Make certain your hardware is adequate for the size and demands of the data formulation and processing. You cannot afford to have inadequate hardware that will impact your overall assessment process efficiency when time lines for transmission have been shortened and noncompliance with transmission deadlines could result in payment issues.

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Comments

FYI - PPS started July 1998 (we were attending DHS meetings on its implementation just prior to our home's opening in August 1998). And electronic transmission started in 1996 during my first MDS coordinator job for another facility.

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