CHANGE IS COMING MDS 3.0

1. CHANGE IS COMINGMDS 3.0 LORI COSTA REGULATORY AND CLINICAL CONSULTANT AGING SERVICES OF CALIFORNIA APRIL 2010

2. INTRODUCTION • “PERFECT DOESN’T EXIST, CHANGE IS GOOD” • SEMINAR SCHEDULE • AGENDA FOR TODAY

3. IN THE BEGINNING • CONTRACT WITH HARVARD UNIVERSITY AND RAND CORPORATION • RESPONSIVE TO CHANGES TO NURSING HOME CARE, RESIDENT CHARACTERISTICS, ASSESSMENT METHODS, AND PROVIDER AND CONSUMER CONCERNS ABOUT MDS 2.0 PERFORMANCE

4. IN THE BEGINNING • FINAL REPORT – DEVELOPMENT & VALIDATION OF A REVISED NURSING HOME ASSESSMENT TOOL; MDS 3.0 • http://www.cms.gov/NursingHomeQualityInits/25_NHQIMDS30.asp

5. MDS 3.0 GOALS • ADVANCES IN ASSESSMENT MEASURES • INCREASE CLINICAL RELEVANCE OF ITEMS • IMPROVE THE ACCURACY AND VALIDITY OF THE TOOLS • INCREASE THE RESIDENTS VOICE

6. MDS 3.0 GOALS • IMPROVE THE TOOL’S CLINICAL UTILITY AND ACCURACY • MAINTAIN ABILITY TO USE DATA FOR QUALITY INDICATORS, QUALITY MEASUSRES AND PAYMENT

7. METHODS • INTERACTIVE PROCESS FOR CONSTANT INPUT • VALIDATION AND EVALUATION • 71 COMMUNITY NURSING HOMES • 19 VA NURSING HOMES

8. KEY FINDINGS • IMPROVED RESIDENT INPUT • IMPROVED ACCURACY AND RELIABILITY • IMPROVED EFFICIENCY • IMPROVED STAFF SATISFACTION AND PERCEPTION OF CLINICAL UTILITY

9. POLICY • MEDICARE AND MEDICAID CERTIFIED FACILITIES • ASSESSMENT, QUALITY MEASURES AND MEDICARE PAYMENT • STATE DATA COLLECTION

10. CMS CHANGES • D – ADDED TWO ITEMS • F – REMOVED FOUR ITEMS • G – REMOVED ITEMS • I – ADDED EIGHT ITEMS • J – REMOVED 2 AND ADDED 3 ITEMS • M – ADDED RISK ITEMS, ADDED FOUR ITEMS AND REMOVED ONE, ASKED FOR DATE INFORMATIONS

11. CMS CHANGES • N – ADDED FOUR ITEMS • O – ADDED COLUMNS AND ITEMS • Q – SOME CHANGES

12. IMPORTANT DATES • UPDATED MANUAL AND FORM MAY OR JUNE 2010 • NEW QUALITY MEASURES ON NURSING HOME COMPARE APRIL OR MAY 2012 • TRAINING MATERIALS ON CMS WEBSITE JUNE 2010

13. IMPORTANT DATES • RUGS TRAINING SUMMER S010 • RUGS IV IMPLEMENTATION OCTOBER 2011 – COLLECTION BEGINS OCTOBER 2010 • RUGS IV UPDATED DECEMBER 2010 • FIRST TRIGGER UPDATES & OTHERS JANUARY 2011

14. IMPORTANT DATES • APPENDIX P REVISION JUNE 2010

15. OVERVIEW OF CHANGES • RAI SYSTEM • MDS MANUAL • ASSESSMENT FORMS

16. RAI SYSTEM • THE RAI SYSTEM IS NOT THE ENTIRE STANDARD OF PRACTICE FOR RESIDENT ASSESSMENT • QUESTION OF WHO CAN ASSESS KEEPS COMING UP • ADDS NEW ASSESSMENTS

17. RAI SYSTEM • CHANGES TIMELINES • DATA WILL GO DIRECTLY TO CMS REPOSITORY • WILL BE ABLE TO PRINT OUT SOME CLARIFYING REPORTS FROM CASPER • SOME ITEMS WILL BE SELF POPULATED

18. RAI SYSTEM • QUARTERLY – NOT ALL ITEMS ARE ACTIVE • SECTION Z ADMINISTRATION OF ASSESSMENTS AND ATTESTATIONS • UPDATES WILL CONTINUE

19. MANUAL • I – INTRODUCTION • II – INSTRUCTIONS AND SCHEDULE FOR COMPLETING ASSESSMENTS • III – ITEM-BY-ITEM GUIDE TO MDS 3.0 • IV – CARE AREA ASSESSMENT (CAA) PROCESS AND CARE PLANNING • V – SUBMISSION AND CORRECTION OF ASSESSMENTS

20. MANUAL • V – SUBMISSION AND CORRECTION OF ASSESSMENTS • VI – SNF PPS • APPENDICES

21. APPENDICES • GLOSSARY AND COMMONS ACRONYMS • STATE AGENCY AND CMS REGIONAL OFFICE CONTACTS • CARE AREA ASSESSMENT RESOURCE • INTERVIEWING TECHNIQUES

22. APPENDICES • COGNITIVE PERFORMANCE SCORING RULES • MDS DRAFT MATRIX • REFERENCES • FORMS

23. ASSESSMENT FORM • SIGNIFICANT VS. MINOR CHANGES • MORE INSTRUCTIONS • CLEARER GUIDANCE FOR CODING • LOOK BACK PERIODS CHANGED • LOOK BACK PERIOD SHORTENED IN MOST PLACES

24. ASSESSMENT FORM • MORE FORMS • INTERVIEW ITEMS • SCRIPTED TESTS • SKIP PATTERNS • CHANGE IN RESPONSE CHOICES • OPTIONAL ITEMS • LARGER FONTS

25. ASSESSMENT FORM • COMBINED RESPONSE CATEGORIES • LOGICAL GROUPING AND PAGE BREAKS • CONSISTENT PATTERNS FOR RESPONSE TYPES • SEPARATION OF MULTIPLE ITEMS • DEFINITIONS ON FORM

26. ASSESSMENT FORM • DELETION OF POORLY PERFORMING ITEMS • CONSOLIDATION OF ITEMS • ENTRY AND DISCHARGE DATA • PASRR INFORMATION IN SECTION A • ITEMS MAY ASK FOR NUMBER OF DAYS OR TIMES

27. ASSESSMENT FORM • MISSING • FECAL IMPACTION • MODES OF EXPRESSION • LAB TESTS • INFECTIONS • ADVANCE DIRECTIVES • FLUID BALANCE • WEIGHT GAIN

28. SKIP PATTERNS • IN ASSESSMENT SECTIONS AS WELL AS IN ITEM CODING • MORE PREVALENT IN INTERVIEW SECTIONS • SECTIONS WITH SKIP PATTERNS • A, B, C, D, E, F, H, J, K, M, N, O, Q

29. NO SKIP PATTERNS • SECTIONS WITH NO SKIP PATTERNS G, L AND P • DON’T SKIP MANDATED DATA IN SKIP PATTERN SECTIONS

30. NEW TESTS • BIMS – COGNITIVE ASSESSMENT • PHQ-9 – MOOD ASSESSMENT • PHQ-9OV MOOD ASSESSMENT • CAM – MENTAL STATUS

31. INTERVIEWS • C – COGNITIVE PATTERNS • D – MOOD • F – PREFERENCES FOR CUSTOMARY ROUTINE AND ACTIVITIES • J – HEALTH CONDITIONS • Q – RETURN TO COMMUNITY • G – ADL – RESIDENT QUESTION

32. EXAM • ORAL AND DENTAL • BALANCE TEST

33. SECTION S • CALIFORNIA LISTED AS COLLECTING POLST DATA • NO LEGISLATION • NO MANUAL INSTRUCTIONS • CDPH SAYS AT THIS TIME IT IS VOLUNTARY

34. WHAT NURSES FOUND • THE CHANGE IS NOT MEDS 2.0 TO 3.0. THE CHANGE IS THE OLD YOU TO THE NEW YOU • DOCUMENT TAKES NURSES BACK TO RESIDENT CENTERED CARE • PAPER CARE TO RESIDENT CARE • NURSES GATHERED INO THE FACILITY NURSES DIDN’T KNOW

35. WHAT NURSES FOUND • RESIDENTS SAID NO ONE ASKES ME WHAT I WANT, THEY JUST TELL ME WHAT TO DO • FACILITY NURSES KEPT SAYING RESIDENTS NON INTERVIEWABLE – NURSE ASSESSORS FOUND OTHERWISE

36. WHAT NURSES FOUND • FOUND SIGNIFICANT RESIDENT FINDINGS • ONCE LEARNING CURVE DECREASES TIME WAS MUCH LESS

37. WHAT YOU NEED TO DO NOW !!!!! • DO ANALYSIS OF CURRENT SYSTEM • HAVE A PLANNED & COORDINATED APPROACH • INVOLVE YOUR CONTRACTED SERVICES, CONSULTANTS, SOFTWARE VENDOR • DECIDE WHO IS GOING TO DO WHAT • PRACTICE INTERVIEWS • GET FAMILIAR WITH TEST QUESTIONS

38. WHAT YOU NEED TO DO NOW !!! • PLAN AND START INSERVICE PROGRAMS • CONSIDER CULTURAL AND LANGUAGE BARRIERS • DEVELOP TOOLS – REMEMBER WE ARE OUR OWN WORST PAPER ENEMY • FIND PRIVATE PLACE FOR INTERVIEWS

39. WHAT YOU NEED TO DO NOW !!! • BUDGET THE RESOURCES THAT YOU WILL NEED-STAFF,EQUIPMENT ETC. • CHANGE THE NECESSARY POLICIES, PROCEDURES AND SYSTEMS • EDUCATE YOUR PHYSICIANS • RESIDENT ORIENTATION

40. THE FUTURE • IF YOU DON’T CHANGE THE CULTURE OF THE NURSING HOME WHO WILL? • MDS 3.0 IS CULTURE CHANGE IN ACTION.