MDS 3 0 Powerpoint for ANHA - Capital Real Estate...
23
11/23/2011 1 Overview • Focus on Resident Voice • Assessment Schedule • EOT OMRA and New Resumption Items New PPS Assessment: COT OMRA • New PPS Assessment: COT OMRA • CMS Clarifications • Coding • New Quality Measures Draft MDS and Care Planning as Risk Management Involve resident and family in care plan meetings. Document resident and family satisfaction with care delivery with care delivery. Use the care plan to develop relationships with residents! Incorporate resident responses from MDS interviews into care plan AND in care delivery.
Transcript of MDS 3 0 Powerpoint for ANHA - Capital Real Estate...
11/23/2011
1
Overview
• Focus on Resident Voice• Assessment Schedule• EOT OMRA and New Resumption Items
New PPS Assessment: COT OMRA• New PPS Assessment: COT OMRA• CMS Clarifications• Coding• New Quality Measures Draft
MDS and Care Planning as Risk Management Involve resident and family in care plan
meetings.Document resident and family satisfaction
with care deliverywith care delivery. Use the care plan to develop relationships
with residents! Incorporate resident responses from MDS
interviews into care plan AND in care delivery.
11/23/2011
2
Proactive vs. Reactive Relationship
Positive vs. Negative interactions build positive instead of negative relationships. If a phone call at midnight is your first or interaction this
sets a negative tone. If you interaction is always problem based…
You will build a negative relationship.
Move toward families and resident when things are going well, not just when there are problems!
Decreases risk by creating positive interactions leading to positive relationships.
What do you do to create a positive relationship with the resident and family?Seek out reasons to contact families with positive
information from your assessment and care planMake it easy for family and residents to attend care y y
plan meetings. Schedule to their convenience not yours.Inform families of what you’re doing for their loved
one. Utilize the family’s knowledge of the resident.
Remember to give yourself credit for what you do! Document attendance of family and resident
in the care plan process. Sign care plan attendance record or sign the Sign care plan attendance record or sign the
care plan.Document how you will accommodate
preferences in the care plan.
11/23/2011
3
COT OMRA Clarifications
COT OMRA and Day of Discharge If Day 7 of the COT observation period is also the day of discharge, then a COT OMRA would not be g ,required.
COT OMRA and Scheduled PPS Assessments If the ARD of a scheduled PPS assessment is set for on or prior to Day 7 of the COT observation period, then no COT OMRA would be required.
COT OMRA Clarifications COT OMRA and Index Maximization
In some situations a resident may simultaneously meet the qualifying criteria for both a therapy and a non-therapy RUG. For some of these cases the RUG-IV per diem payment rate for the non-therapy RUG will be higher; therefore although the resident is receivinghigher; therefore, although the resident is receiving therapy services, the index maximized RUG is a non-therapy RUG.
A facility is required to complete a change of therapy evaluation for all patients receiving any amount of skilled therapy services, including those who have index maximized into a non-therapy RUG group.
COT OMRA Index MaximizationWhat does that mean?
Evaluate…. Decide if a COT OMRA is needed or not needed!
*RTM’s*Number of Therapy Disciplines*Number of Therapy Days*Restorative Nursing (Low Rehab)
11/23/2011
4
A COT OMRA is only required for residents in such cases that the therapy services received during the COT observation period is no longer reflective of the RUG-IV category after considering indexcategory after considering index maximization.
Consider the following two examples:
Example #1:
Resident qualifies for RMB but index maximizes into HC2. During the COT observation period, resident receives onlyobservation period, resident receives only enough therapy to qualify for RLB.
COT OMRA not required because no change to index maximized RUG category
Example #2:
Resident qualifies for RMB but index maximizes into HC2. During the COT b ti i d id t i hobservation period, resident receives enough
therapy to qualify for RUB.
COT OMRA is required because of change to index maximized RUG
11/23/2011
5
See attachment
COT OMRA Clarifications Completing resident interviews on COT OMRA
Providers are encouraged to complete resident interviews in as timely a manner as possible, te e s as t e y a a e as poss b e,which in the case of a COT OMRA might occur 1-2 days after the ARD of the COT OMRA.
Every effort should be made to provide the residents an opportunity to make their voices heard!
Leave of Absence (LOA) Policy Clarification Scheduled PPS Assessments
The Medicare assessment schedule is d d l d h hadjusted to exclude the LOA when
determining the appropriate ARD for a given assessment.
11/23/2011
6
Example:
A resident leaves SNF X at 6:00pm on Wednesday (Day 27) and returns to the SNF on Thursday at 9:00am. Wednesday becomes a non-billable day and Thursday becomes Day 27 of the resident’s stay.
Leave of Absence (LOA) Policy ClarificationUnscheduled PPS Assessments
Days during which a resident experiences b d d han LOA must be counted toward the ARD
for a given unscheduled assessment.
EOT OMRA Example: A resident does not receive therapy on Monday and Tuesday, and Wednesday, goes to the emergency room at 9:00pm on Wednesday and returns to the facility onWednesday and returns to the facility on Thursday at 10:00am, Whether or not therapy is provided on Thursday, an EOT OMRA would be required with an ARD set for Monday, Tuesday, or Wednesday.
11/23/2011
7
Leave of Absence (LOA) Policy Clarification
Unscheduled PPS Assessments
Days during which a resident experiences an LOA must be counted toward the ARD for a given unscheduled assessment.
COT OMRA Example:If the ARD for a resident’s 30-day assessment were set for November 7 and the resident went to the emergency room at 11:00pm on November 9 returning at 2:00pm on NovemberNovember 9, returning at 2:00pm on November 10, Day 7 of the COT observation period would remain November 14.
Note: The COT evaluation process and payment implications remain unchanged.
Leave of Absence (LOA) Policy Clarification
Question: Can the ARD set of an unscheduled PPS assessment be set for an LOA d ?LOA day?
11/23/2011
8
Leave of Absence (LOA) Policy Clarification
Answer: Yes; it is possible that the ARD for a given unscheduled PPS assessment may b t f LOA dbe set for an LOA day.
Leave of Absence (LOA) Policy Clarification
Question: If a resident experiences an LOA during the observation period for an
t th i id d tassessment, can the services provided to that resident during the LOA be coded on the MDS?
Leave of Absence (LOA) Policy Clarification
Answer: Yes; such services may be coded on the MDS, though only in those cases
h d i ld t i l t thwhere doing so would not violate any other provisions of the RAI manual or other such SNF PPS guidelines.
11/23/2011
9
Leave of Absence (LOA) Policy Clarification
Scenario: A resident leaves the SNF for the
emergency room on Monday at 9:00pm and returns on Tuesday at 11:00am. A COT evaluation is done on Thursday. If therapy was provided early Monday morning, can this therapy be coded on the MDS?
Leave of Absence (LOA) Policy Clarification
Solution: Yes; therapy provided by the SNF on the day the resident experiences the LOA
b t d t d th COT l timay be counted toward the COT evaluation.
Use of Dashes for Interviews. Every effort should be made to interview the
resident on or before, or as near to the ARD as possible.I i t h di h In circumstances where discharge occurs unexpectedly and the interview cannot be completed.
Follow instructions from CMS Memo.
11/23/2011
10
See Attachment
Section D.0300, Mood (PHQ-9)
Notify Mental Health Specialist for any score > 12.
Section D.0200.1.I. and D.0200.2.I.
Involve Physician for any “yes” and coding “1”, “2”, or “3”; for “better off dead…..”.
Section E.0800, Rejection of Care & Frequency
Instructions in the manual changed, page E 15 f Ch t 3E-15 of Chapter 3.
Prior RAI Manual wording used was-“and/or”
11/23/2011
11
Section E.0800, Rejection of Care & Frequency
Current RAI Manual Update:
Do not include behaviors that have already been addressed (e.g., by discussion or care planning with the resident or family) and are determined to be consistent with resident values, preferences or goals.
Section F0400.A-H., Preferences for Customary Routine and Activities
Utilize responses in your activity care plan t d t t h i t dto demonstrate you have incorporated “Resident Voice” into your care delivery.
*Very Important*Somewhat Important
Section F0400.A-H., Preferences for Customary Routine and Activities
Resident Responses “Important but can’t do h i ” h ld h i ifi tor no choice” should have significant
clarification in the record!!
11/23/2011
12
Section H. , Bladder and Bowel
Associated F-Tags:
*F315*353*501
J0300, J0400, J0500, J0600; Pain
Must use resident’s responses to these questions in establishing and adjusting
id t’ i t iresident’s pain management regimen as reflected at the time of the ARD!
O0250 and O0300, Flu/Pneumovax
Associated F-Tag:*F334
11/23/2011
13
SCSA-Significant Change in Status Assessment
Must be completed upon any resident lli i H i dl f h thenrolling in Hospice regardless of whether
any significant change in status criteria are met. Chapter 2, Section 2.6, page 2-21.
Research Triangle Institute International
Most recent Draft Dated 9-29-2011
Subject to Change
Short Stay 11 Measures Qualifying Reasons for Target
Assessment*Ad i i A l SCSA Q l*Admission, Annual, SCSA, Quarterly, Significant Correction, Quarterly, DC-RA, DC-RNA*5-Day, 14-Day, 30-Day, 60-Day, 90-Day, Readmission/Return Assessment
11/23/2011
14
Short Stay
Qualifying Reasons for Initial Assessment
*Admission, 5-Day, Or Readmission/Return assessment, DC-RA, DC-RNA
Long Stay18 Measures
Qualifying Reasons for Target Assessment*Admission, Annual, SCSA, Quarterly, Si ifi C i (C h iSignificant Correction(Comprehensive or Quarterly, DC-RA, DC-RNA*5-Day, 14-Day, 30-Day, 60-Day, 90-Day, Readmission/Return assessment
Flu and Pneumococcal Vaccines Measures
Currently, account for Eight Measures under Short and Long Stay Categories!
11/23/2011
15
Flu and Pneumococcal Measures
% of residents assessed and appropriately given the seasonal flu vaccine.
Flu and Pneumococcal Measures
% of residents who received the seasonal flu vaccine.
Flu and Pneumococcal Measures
% of residents who were offered and declined the seasonal flu vaccine.
11/23/2011
16
Flu and Pneumococcal Measures
% of residents who did not receive, due to medical contraindication, the seasonal flu
ivaccine.
Flu and Pneumococcal Measures
% of residents assessed and appropriately given the pneumococcal vaccine.
Flu and Pneumococcal Measures
% of residents who received the pneumococcal vaccine.
11/23/2011
17
Flu and Pneumococcal Measures
% of residents who were offered and declined the pneumococcal vaccine.
Flu and Pneumococcal Measures
% of residents who did not receive, due to medical contraindication, the pneumococcal
ivaccine.
Remaining Three Short Stay Measures
• Falls• Pain• Pressure Ulcers
11/23/2011
18
Short Stay Measures
Pain:% of residents on a scheduled pain medication
d h lfregimen on admission who self-report a decrease in pain intensity or frequency.
Short Stay Measures
Pain:% of residents who self-report moderate to severe pain.
Short Stay Measures
Pressure Sores:% of residents with pressure ulcers that are new or worsening.
11/23/2011
19
Remaining Ten Long Stay Measures
*Falls *Catheters *Pain *Restraints
l ’*Pressure Ulcers *ADL’s*Urinary Tract Infections *Weight Loss*Bladder or Bowel *Mood
Long Stay Measures
Pain:% of residents who self-report moderate to severe pain.
Long Stay Measures
Falls:% of residents experiencing one or more falls
hwith major injury.
11/23/2011
20
Long Stay Measures
Pressure Ulcers:% of high-risk residents with pressure ulcers.Risk Adjustment:
Long Stay Measures
Urinary Tract Infections:% of residents with a UTI
Long Stay Measures
Bladder/Bowel:% of low-risk residents who lose control of h bl dd b ltheir bladder or bowel.
Risk Adjustment:
11/23/2011
21
Long Stay Measures
Catheters:% of residents who have/had a catheter
d d l f h bl ddinserted and left in their bladder.
Long Stay Measures
Restraints:% of residents who were physically restrained.
Long Stay Measures
ADL’s:% of residents whose need for help with
ti iti f d il li i h i dactivities of daily living has increased.
11/23/2011
22
Long Stay Measures
Weight Loss:% of residents who lose too much weight.
Long Stay Measures
Mood:% of residents who have depressive symptoms.
Research Triangle Institute International:http://www.rti.org
National Provider Call Slides from 11-3-2011:www.cms.gov/SNFPPS/03_RUGIVEdu12.asp
11/23/2011
23
MDS 3.0 CMS: www.cms.gov/NursingHomeQualityInits/45_NHQIMDS30TrainingMaterials.asp#
Dashes Memo @ CMS:http://www.cms.gov/NursingHomeQualityInits/Downloads/MDS30TheUseOfDashes.pdf
