1 / 40

CHANGE IS COMING MDS 3.0

CHANGE IS COMING MDS 3.0. LORI COSTA REGULATORY AND CLINICAL CONSULTANT AGING SERVICES OF CALIFORNIA APRIL 2010. INTRODUCTION. “PERFECT DOESN’T EXIST, CHANGE IS GOOD” SEMINAR SCHEDULE AGENDA FOR TODAY. IN THE BEGINNING. CONTRACT WITH HARVARD UNIVERSITY AND RAND CORPORATION

Rita
Télécharger la présentation

CHANGE IS COMING MDS 3.0

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  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.

More Related