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Hospital & Health System Association of Pennsylvania Achievement Award 2006

Hospital & Health System Association of Pennsylvania Achievement Award 2006. MDS Coding: A Cultural Change. FCMC Mission & Vision . Mission To continuously improve the health of our community. Vision

JasminFlorian
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Hospital & Health System Association of Pennsylvania Achievement Award 2006

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  1. Hospital & Health System Association of Pennsylvania Achievement Award 2006 MDS Coding: A Cultural Change

  2. FCMC Mission & Vision • Mission • To continuously improve the health of our community. • Vision • To become the Heath Care provider of choice in Fulton County by providing state of the art products and services to our community in a way that reflects our commitment, our competence and our compassion.

  3. Problems that were recognized • Recognized Supporting Documentation for Section G was not accurate • Incorrect Coding resulted in: • Inaccurate resident ADL assessments • Not obtaining the appropriate reimbursement rate • QM indicated a 33% decline in ADL function as reported by CMS for 4th Quarter 2003

  4. Data Collection • Base line needed to determine staff’s ability to accurately code Section G of the MDS • ADL Audit Tool Comparing the LPN documentation and the CNA’s verbal interpretation regarding Section G Results: Inconsistencies in capturing highest functional level of care

  5. Intervention • Interdisciplinary ADL training occurred on: • ADL Definitions • Proper Coding • Significance of accurate coding

  6. Question: Were we on the right track? • Second Audit was completed • Results • ADL coding accuracy was at 44%

  7. Further Findings • The LPNs were completing the ADL tracking forms. • The ADL Trackers were being completed after the change in shift thus not capturing direct caregivers input • There was a lack of understanding in regards to the coding definitions • Inconsistencies in interpreting ADL tracking form

  8. What next? • More education was needed: • LPNs were instructed on accurately completing the tracking form • Education on communicating with front line care givers on ADL functioning in regards to the residents • Reeducated on ADL definitions

  9. 3rd and final audit • Administered ADL coding quizzes to all of the LPNs • Results • 37% accuracy rate

  10. Assessment Findings • ADL trackers were completed by both LPNs and CNAs for a select group of residents • This determined that our most accurate data was obtained from the direct care staff • This made it evident that a cultural change was needed

  11. Implementation Process • Development of the “ADL Core Training Group”. • Incorporating CNAs from every shift • Those who completed the highest “clinical ladder” • This allowed for an individual to be available at all times for: • Clarification of definitions • Coding Instructions • Mentoring coworkers in accurate ADL Coding

  12. Intensive Training • This occurred over a two month period • This was conducted by: • The MDS Coordinator • Restorative Nursing Coordinator • As well as the complete support of the NHA and DON

  13. Objectives • Objectives for the training included: • Understanding the importance of accurate coding • Understanding the effects this has on the true level of care and reimbursement • Purpose and frequency of the MDS • Significance of interdisciplinary contribution • Coding and ADL definitions • Identifying resident ability • Identifying staff assistance required

  14. Development of a new ADL Tracker A new ADL tracker form was developed by and tailored for effective use by the CNAs PLEASE SEE HANDOUT

  15. Testing of ADL Core Group • ADL Core Group (total of ten individuals) was quizzed using the MDS manual to ensure their level of understanding • Results • 100% accuracy

  16. Ongoing Training • Education was provided to all CNAs • New Policy and Procedures were developed • Implementation of: • CNA completing ADL Tracker Form beginning January 1st 2005

  17. Summary • Our goal was to have 95% accuracy • We obtained a 98% accuracy and continue to maintain that rate • Our CMI increased from a 1.10 to a 1.20 • Our Quality Measure for ADL decline dropped from 33% to 12%

  18. How do we maintain Accurate ADL Coding • We perform ongoing education 4 times a year that is fun and entertaining • Jeopardy Games • Themed educational sessions (with quizzes) • ADL Newsletter • With quiz attached • Flow chart to assist with ADL coding (please see handout) • Continue Audits • 1:1 education as needed

  19. Credits • Quality Insights of PA • Nursing Staff • Jeff Thomas • Administration • MDS Coordinator • Restorative Nursing Coordinator • Therapies • HAP

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