Nursing Homes and MDS 3.0 – the Winds of Change are Upon Us

changes ahead sign

Well, it’s here.  MDS 3.0.  A couple of years in the making, about 6 months of training made available to SNF providers, and with the tears and fears of MDS nurse assessors blanketing the countryside, CMS implemented it.

For those of us with a history of working in the Nursing Home Industry, never has a date been so permanently etched in our minds.  October 1st, 2010.  This date changed how we looked at, interviewed and discussed our residents forever.

Nursing Home Staff Training on MDS 3.0  –  mobilizing the workforce

As a consultant to the nursing home industry, during the months of summer 2010, I watched the staff of my skilled nursing facility (SNF) clients prepare for their implementation of MDS 3.0.  They signed up for repeat offsite MDS 3.0 training classes, they reviewed the new Resident Assessment Instrument (RAI) manual, they participated in webinars.  The clinical software used by my clients had a built-in MDS 3.0 training module to practice with  –  and nursing facility staff used it as a trial run.  They also requested new tools …

  • interview cue cards to help with the increased detail of the new patient assessment under MDS 3.0
  • laminated pain assessment scales that could be easily kept with them and be readily available to help with such patient assessments as they presented themselves
  • and laminated “cheat sheets” to help them with completing the lengthy MDS 3.0 documentation and Care Area Assessments (CAA’s).

Software vendors with SNF clients had to deal with change, too.  As CMS or the various states revised processes or requirements leading up to the implementation date, then the SNF’s clinical software needed changes too.  And sometimes on a daily basis – more or different processes to learn.

And let’s not forget the facility Information Technology (IT) staff, or contracted vendor, who was responsible for uploading the software changes.

The SNF Business can Create Creatures of Habit …

To some degree, I believe we are all creatures of habit.  From what I’ve observed in my professional life, people have a tendency to “maintain the same”.  The unconscious decisions as to what to do, when to do it, and even, where to sit in staff meetings.  I’ve attended more staff meetings than I care to count, and almost without fail, people seem to pick a seat in the same location in a room or around a conference table.  This one likes to sit facing a window.  That one always sits at the right side of “the boss”.  It makes no difference if the meeting is a daily one or a monthly department head or management meeting.  We are mostly creatures of habit and establish our comfort zone, even when we select our place in a meeting.  It’s a subtle indication that many people don’t like or want change.

… but with CMS, Change in the Long-Term Care Industry is Inevitable

When Medicare reimbursement moved from a cost basis to PPS/RUG III in 1998, the MDS Nurse Assessor was the key individual in the SNF to gather info from the patient medical record and obtain the MDS 2.0 RUG that would define the level of care and ultimately, the money due the facility.  With MDS 3.0, CMS is looking for a more comprehensive documented description of the nursing home patient.  The questions are more detailed, require measurements or determination of location of events.  And it provides a platform for the patient’s voice, taking the question “how do you feel” to a new, more intensive level.  Staff still wonder,  “What will all these changes bring in the future?”

As a consultant to nursing homes and their reimbursement issues and strategies, my clients are using a team approach to address the challenges  brought on by MDS 3.0.  The entire Interdisciplinary Team (IDT) is responsible for specific sections, and the MDS Nurse acts like the gatekeeper.  All members of the IDT had to change their daily routines, so that chart reviews and patient interviews were completed timely.  And there were mixed feelings about the changes, not surprisingly.  Some staff have liked the changes, and others haven’t – particularly when some patients complained that “you just asked me all those questions last week!”.

CMS is addressing concerns about the number of interviews that the SNF’s must do, as they mentioned in a recent “Open Door Forum”.  I guess there will probably be more changes coming our way, once CMS reviews all the data they gather from the MDS assessments and feedback from providers.  When a provider is Medicare certified they can always count on one consistency in life … there will be change.

So I say, “Embrace it.”  Doing so will continue to move your organization toward its best possible outcome.

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