MDS-RCA Training - Maine.gov · Quality Indicators 2 MDS-RCA Training: ... MDS-RCA Training: RUG...
Transcript of MDS-RCA Training - Maine.gov · Quality Indicators 2 MDS-RCA Training: ... MDS-RCA Training: RUG...
MDS-RCA Training Aug 2015 9/1/2015
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MDS-RCA Training
Case Mix TeamOffice of MaineCare ServicesAugust 2015
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MDS-RCA Training: Agenda
History of MDS-RCAPurpose:DefinitionsSchedule of AssessmentsCase Mix Index, RUGsAccuracy and SanctionsMDS-RCA Assessment ToolCorrection PolicyQuality Indicators
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MDS-RCA Training: History
In 1994 a workgroup made up ofproviders, Muskie School and DHHSrepresentatives was established toprovide recommendations fordevelopment of:
o MDS-RCA form design and contento Classification systemo Case Mix payment systemo Quality Indicators
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MDS-RCA Training: History
1995 Time StudyTwenty five facilities, with a total of 626residents, participated in this time study.This included the following residents:
o In small facilitieso With head injurieso With Alzheimer’s Diseaseo With Mental illness
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MDS-RCA Training: History
1999 Time Study
Thirty-two Facilities, with a total of 735residents, participated in another time study.Facilities were selected according to:
o Overall populationo Presence of complex residentso Presence of residents with mental health
issueso Presence of residents with Alzheimer’s or
other Dementiao Presence of elderly population
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MDS-RCA Training: History
1999 Time Study Results
o Residents were more dependent inADL’s
o There was an increase in residents withAlzheimer’s and other Dementias.
o There was an increase in wanderingand intimidating behaviors.
o There was an increase in the amount oftime needed to care for these residents
o The Case Mix Grouper needed to berevised
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MDS-RCA Training: Purpose
Who, What, Where, Why and,When…
of Case Mix
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MDS-RCA Training: Purpose
So… Who completes the MDS-RCA?
…The MDS-RCA Coordinator
with help from:
The resident
Personal Support Specialists
CRMA
family
clinical records
Social Services
dietary, activities and other staff8
MDS-RCA Training: Purpose
And… What is Case Mix?
Case Mix is a system of reimbursement thatpays facilities according to the amount oftime spent providing care to residents.
Residents are grouped according to theamount of time needed to provide their care
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MDS-RCA Training: Purpose
And… Where is the assessment done?
MDS-RCA assessment is completed in thefacility
All residents
Regardless of payer source
The MDS-RCA cannot be completed if theresident is not in the facility. For example, ifin the hospital or on a therapeutic leave
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MDS-RCA Training: Purpose
And… Why do we need to do MDS-RCAAssessments?
1. To provide information to guide staff indeveloping a realistic individualized ServicePlan.2. To place a resident into a paymentgroup within the Case Mix System.3. To provide information that determinesthe Quality Indicators.4. To show an accurate picture of theresident’s condition, the type and amountof care needed 11
MDS-RCA Training: Purpose
So… Why do we need to do MDS-RCAAssessments? (cont.)
5. Improve equity of payment toproviders
6. Provide incentives to facilities foraccepting residents with higher careneeds
7. Strengthens the quality of care andquality of life for residents.
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MDS-RCA Training: Purpose
Schedule of Assessments:
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MDS-RCA Training: Purpose
When to complete a Significant ChangeMDS-RCA assessment:
• Resident has experienced a “majorchange”
• Not self-limited• Impacts more than one area of the
resident’s clinical status• Requires review and/or changes to the
service plan• Improvement or decline• Completed by the end of the 14th day
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MDS-RCA Training: Timeliness and Accuracy
Timeliness
MaineCare Benefits Manual, Chapter III, Section97, §7060.1:
“The Department will sanction providers for failureto complete assessments completely, accuratelyand on a timely basis.”
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MDS-RCA Training: Timeliness and Accuracy
Accuracy
Each assessment must be conducted orcoordinated by staff trained in the completion ofthe MDS-RCA.
Documentation is required to support thetime periods and information coded on theMDS-RCA. (MBM, chapter III, Section 97,Appendix C, §7030.3)
Penalty for Falsification: The provider may besanctioned whenever an individual willfully andknowingly certifies (or causes anotherindividual to certify) a material and falsestatement in a resident assessment.
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MDS-RCA Training: Case Mix Review
Case Mix Quality Assurance Review
About every 6 months, a Case Mix nursereviews a number of MDS-RCAassessments and resident records to checkthe accuracy of the MDS-RCAassessments.
Insufficient, inaccurate or lack ofdocumentation to support informationcoded on the MDS-RCA may lead to anerror.
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MDS-RCA Training
Poor Documentation could mean…
Lower payment than the facility couldbe receiving, OR
Overpayment which could lead to re-payment to the State (Sanctions). This isdue to either overstating the care aresident received or insufficientdocumentation to support the care thatwas coded.
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MDS-RCA Training: Sanctions
Sanctions:
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MDS-RCA Training: Purpose
Case Mix Resident ClassificationGroups and Weights
There are a total of 15 case mixclassification or RUG (ResourceUtilization Groups) groups, includingone default group used when aresident cannot be classified into oneof the other 14 classification groups.
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MDS-RCA Training: Case Mix Review
5 categories:
• Impaired Cognition• Clinically Complex• Behavioral Health• Physical• Default or Not Classified
The Department assigns each casemix classification group a specificcase mix weight, as follows…
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MDS-RCA Training: Purpose
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MDS-RCA Training: RUG Groups
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ADL Function Self-PerformanceMDS-RCACode
ADLScore
1. Bed Mobility (G1aa)
2. Transfer (G1ba)
3. Locomotion (G1ca)
4. Dressing (G1da)
5. Eating (G1ea)
6. Toilet Use (G1fa)
7. Personal Hygiene (G1ga)
Independent 0 0
Supervision 1 1
Limited Assistance 2 2
Extensiveassistance
3 3
Total Dependence 4 4
Activity did notoccur
8 4
The ADL index score is determined as follows:
MDS-RCA Training: RUG Groups
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Impaired Cognition Groups
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Clinically Complex Groups
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Behavioral Health Groups
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Physical and Default groups
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MDS-RCA Training: Purpose
Documentation errors vs. Payment errors
• A Payment error counts towards the final“error rate” presented at the time of theexit interview.
• A Documentation or clinical error does notcount towards the final error rate.
• Both types of errors must be corrected
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MDS-RCA Training: Assessment Tool
MDS-RCA Assessment Tool
Section by Section
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Section AA: IdentificationInformation.
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MDS-RCA Training: Assessment Tool
Face Sheet: Background InformationCompleted at the time of the resident’sinitial admission to the facility.
Section AB: Demographic InformationSection AC: Customary RoutineSection AD: Face Sheet Signatures and
dates
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Section A: Identification and Background information
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Section B: Cognitive Patterns
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Section E: Mood and Behavior Patterns (cont)
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ADL SELF-PERFORMANCEMeasures what theresident actually did(not what he or shemight be capable ofdoing) within eachADL category overthe last 7 days.
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MDS-RCA Training: Assessment Tool
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Note: this section has a 14-day look back period.
0 - Continent – Complete control
1 - Usually Continent – Bladder,incontinent episodes occur once aweek or less. Bowel incontinentepisodes occur less than once aweek.
2 - Occasionally Incontinent –Bladder incontinent episode occurtwo or more times a week but notdaily. Bowel incontinent episodesoccur once a week.
3 - Frequently Incontinent –Bladder, tended to be incontinentdaily, but some control present (e.g.,on day shift) Bowel, 2-3 times aweek.
4 - Incontinent – Bladderincontinent episodes occur multipletimes daily. Bowel incontinence isall (or almost all) of the time.
A. Mr. Q was taken to the toilet afterevery meal, before bed, and onceduring the night. He was never foundwet.
B. Mr. R had an indwelling catheter inplace during the entire 14-dayassessment period. He was neverfound wet.
C. Although she is generally continentof urine, every once in a while (aboutonce in two weeks) Mrs. T doesn’tmake it to the bathroom in time afterreceiving her daily diuretic pill
D. Late in the day when she is tired,Mrs. A sometimes (but not all days)has more episodes of urinaryincontinence.
POP QUIZ !
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MDS-RCA Training: Assessment Tool
Section I: Diagnosis
All diseases and conditions must have physiciandocumented diagnosis in the clinical record.
Do not include conditions that have been resolved orno longer affect the resident’s functioning or serviceplan.
Diabetes with daily insulin injectionsAphasiaCerebral palsyHemiparesis/hemiplegiaMultiple sclerosis (MS)QuadriplegiaExplicit terminal prognosis (6 months or less)
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Thesediagnosescontributeto theClinicallyComplexRUGgroups
MDS-RCA Training: Assessment Tool
Section J covers Health Conditions andPossible Medication Side Effects…
A lot of territory!
J1. Problem conditions J2. Extrapyramidal signs and symptoms J3 and 4. Pain Symptoms and location J5 and 6. Pain interference and management J7. Accidents J8. Fall risk
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Delusions and Hallucinations are bothItems that can contribute to the BehavioralHealth RUG groups. Descriptivedocumentation required
Section J. Health Conditions and Possible Medication Side Effects
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Section K: Oral and Nutritional Status
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Section L: Oral / Dental Status
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If M1b is checked, itwill contribute to aclinically complexRUG group
Section M: Skin Condition
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Section M: Skin Condition
If M2a, b, c, or d iscoded greater than0, this item willcontribute to aclinically complexRUG group
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Section N: Activity Pursuit Patterns
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Section O: Medications
This item cancontribute to theclinically complexRUG group, incombination witha diagnosis ofDiabetes
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Section P: Special Treatments and Procedures
These items willcontribute to theclinically complexRUG group
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Section P: Special Treatments and Procedures (cont.)
These items will contribute to aBehavioral Health RUG group if three(3) or more items in P2A – P2J arechecked
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Section P: Special Treatments and Procedures (cont)
These items will contribute to aClinically Complex RUG group
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MDS-RCA Training: Assessment Tool
P4. Rehab / Restorative care
P5. Skill Training
P6. Adherence With Treatments/TherapiesPrograms
P7. General Hospital Stays
P8. Emergency Room (ER) Visit(s)
P9. Physician Visits
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Section P: Special Treatments and Procedures (cont)
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Section P: Special Treatments and Procedures (cont)
Note: Code the number of days the physician changedthe resident’s orders, not including order renewals withoutChange or clarification of orders.
This item will contribute to the ClinicallyComplex RUG group if coded as 4 or more
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P11. Abnormal Lab Values
P12. Psychiatric Hospital Stay(s)
P13. Outpatient Surgery
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Section P: Special Treatments and Procedures (cont)
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Section Q: Service Planning
Note: this item refers toResident self-identified goals
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Section R: Discharge Potential
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Section S: Assessment Information and Signatures
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Section T: Preventive Health
Note: 12 month look back period for preventivehealth measures.
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Section U: Medications list
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CorrectionRequest Form:Prior RecordSection
MDS-RCA Training: Corrections
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CorrectionRequest Form:CorrectionSection
MDS-RCA Training: Corrections
Purpose of this form:To request correction of errors in anassessment or tracking form that hasalready been accepted into the database.
• To modify a record in the database• To inactivate a record in the database
It is important that the information in theState database be correct.
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Correction Request Form
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MDS-RCA Training: Corrections
To INACTIVATE a record in the State database
1. Complete this correction request form2. Create an electronic record of the form3. Place a hard copy of the documents in the
Clinical record4. Electronically submit this request.
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Correction Request Form
MDS-RCA Training: Submission
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The link to the SMS website can befound on the Muskie School of Public
Service, Minimum Data Set (MDS)Technical Information website:
http://muskie.usm.maine.edu/mds/
Click on the link and the SMS log-in screen will appear.Type in your username and password and hit the Log Inbutton to enter the site.
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MDS-RCA Training: Documentation Requirements
Documentation Requirements
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Clinically Complex
MDS-RCA Training: Documentation Requirements (Clinically Complex)
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Impaired Cognition and Problem Behavior
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Physical Impairment
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MDS-RCA Training: Quality Indicators
What are Quality Indicators??
• Identify flags• Identify exemplary care• Identify potential care problems• Identify residents for review• Provide general information• Identify education needs• Based solely from responses on the
MDS-RCA
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Quality Indicator Reports
The “PNMIResidential CareFacility QualityIndicator” report isprepared & mailedto each facility every6 months.
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Quality Indicators
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The QI Report
Allows each facility review the results and compare yourfacility’s percentage to the state average.
What could cause your facility to be higher or lower thanother facilities?
Verify that the resident’s condition was accuratelyassessed at the time the MDS-RCA was completed
Identify if facility changes are needed
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MDS-RCA Training: Wrap up
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MDS-RCA Training: Wrap Up
Reminders:
Quarterly Res Care Forum Calls in March,June, September, and December-
Call the MDS help desk to register.
ASK questions!
ASK more questions!
Attend training as needed
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Contact Information• MDS Help Desk: 624-4019
• Lois Bourque RN: [email protected]
• Darlene Scott-Rairdon RN: [email protected]
• Maxima Corriveau RN: [email protected]
• Heidi Coombe RN: [email protected]
• Sue Pinette RN: [email protected]
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