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Transition to MDS 3.0

September 1, 2009
by Cheryl Field, RN, MSN, CRRN and Jennifer Gross, RN, BSN, BA
| Reprints
Now is the time to prepare staff for 2010 implementation

Long-term care providers continue in a holding pattern awaiting the anticipated transition from MDS 2.0 to MDS 3.0. While exact specifications of MDS 3.0 are not yet known, one fact is certain-the change will be significant, and its effect will be facility-wide. Based on detailed analysis of the most recent draft, significant changes are expected in the methodology for data collection, coding, and reporting. Consequently, now is the time to begin the process of educating staff regarding the timeline for implementation, the overall change in assessment philosophy, and laying the groundwork for a smooth transition to MDS 3.0.

Transition timeline

In March of 2009, The Centers for Medicare & Medicaid Services (CMS) delayed implementation of MDS 3.0 until October 2010. This fortuitous delay grants providers a one-year lead time from the release of final documentation until the revised implementation date of October 2010. Assuming the draft is indicative of the final publication, providers will benefit from advanced preparations. To that end, it's important to review the most recently published timeline and remain informed of future modifications. As of today, key dates include:

  • October 2009: Publication of MDS 3.0 Resident Assessment Manual

  • January 2010: National Quality Forum (NQF) call for Quality Measures

  • February/March 2010: Train the Trainer Educational Forums

  • September 2010: NQF Endorsement of Quality Measures

  • October 1, 2010: Initiate Implementations (National data collection; SNF PPS-based on MDS 3.0 data; and national data collection of QM/QI using MDS 3.0 data)

  • April 2011: Begin analysis of MDS 3.0 quality measure data

  • July 2011: Complete analysis of MDS 3.0 quality measure data

  • October 2011: Begin public reporting using MDS 3.0

(For a complete list of transition dates, visit CMS online at http://www.cms.hhs.gov/NursingHomeQualityInits/Downloads/MDS302010ImplementationTimeline.pdf.)

Change in philosophy

The main objective of MDS 3.0 is to make the resident assessment process more clinically relevant and reliable. To accomplish this, increased emphasis is placed on the residents themselves by expanding the use of resident interviews. While resident interviews have always been a component of MDS 2.0, they have been loosely prescribed with staff often extracting necessary information from the chart, not the resident directly. Studies have shown, however, that asking residents directly about their condition and their preferences conveys respect for the individual and is fundamental to both higher quality of care and higher quality of life.

Based on detailed review of the draft documentation, MDS 3.0 will likely require resident interviews in determination of:

  • Mental status

  • Mood

  • Preferences for daily routine

  • Pain

  • Long-term goals

In each category, the interview process uses standard questionnaires with a methodology for coding responses and ultimately calculating a quantitative score using industry standard scales. The interview process will rely on structured questions with a range of potential answers from which the resident can make a selection. All residents, regardless of cognitive ability, will be assumed capable of participating until determined otherwise. Interestingly, in the pilot study, 90% of residents were able to complete the mental status interview; 86% completed the mood section, and 84% completed the section regarding preferences for daily routine. Should residents be deemed unable to participate, the staff will substitute observations for the interview process.

While the exact specifications of MDS 3.0 remain unknown, the inclusion of resident interviews is certain and will require providers to overcome challenges. Such challenges may include locating a private place to conduct interviews, identifying a process to schedule interviews around resident activities/therapies, addressing potential cultural issues in discussing depression and anxiety, and eliminating potential language/comprehension barriers as a result of impairments that may require new accommodations. At a minimum, it's important for providers to equip staff with the skills necessary to confidently conduct resident interviews.
Cheryl Field, RN, MSN, CRRN

Cheryl Field, RN, MSN, CRRN


Fortunately, MDS 3.0 is a major step forward in redirecting attention away from forms and paperwork back to the resident as an individual. Nurses, in particular, offered favorable reviews in response to the pilot study. Many nurses expressed satisfaction with the dialogue that flowed from the resident-focused approach and credited the interview process with gaining information that would otherwise have gone undetected.
Jennifer Gross, RN, BSN, BA

Jennifer Gross, RN, BSN, BA


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Any info just pertaining to changes in therapy?

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