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 MDS 3.0: Setting The Stage

Experts advise providers to consider organizational structure, processes, and outcomes as they transition from 2.0 to 3.0.

 

​What do quality care plans, purposeful assessments, accurate reimbursement, positive survey results, good public relations, and good quality measures have in common? The answer: a well developed and interdisciplinary approach to the minimum data set (MDS). It’s undeniable. MDS has become the backbone of the long term care industry.
 
As such, a successful transition from 2.0 to 3.0 is mission critical. However, the word “transition” cannot be misconstrued. MDS 3.0 is not a revision of MDS 2.0. In fact, MDS 3.0 takes a radically different approach to resident assessments with extensive philosophical and practical changes.

Backbone Of Long Term Care

MDS is the catalyst to ensure an accurate, thorough, and interdisciplinary approach to resident assessments for the purpose of improving care plans and delivering the best possible quality of care to every resident. However, the data collected through MDS have proven increasingly valuable for a number of other purposes throughout the long term care arena.
 
Today, the majority of revenue for almost any long term care provider is driven by acuity level as captured through MDS. Prospective residents and family members examine publicly available quality measures that are derived from the MDS on the Centers for Medicare & Medicaid Services’ (CMS’) Five-Star Quality Rating System and Nursing Home Compare.
 
The transition to MDS 3.0 presents the perfect opportunity to reexamine not just the resident assessment process, but also the organizational structure and culture as it relates to the significance of the MDS and a commitment to excellence.
 
Click HERE for a list of the significant changes found in the MS 3.0 and tips on how providers should prepare for the transition.

More Than A Transition

MDS 3.0 represents a major shift in assessment philosophy from an observational approach to a focus on resident-directed care. One method MDS 3.0 uses to achieve this construct is through the required use of scripted interviews that incorporate the resident’s own voice into the assessment. Clinicians are required to interview each resident to assess cognition, mood, pain, goals, and preferences.
 
Almost every section of MDS is altered from 2.0, affecting all interdisciplinary team members who contribute to the assessment process.
 
Beyond changes to the assessment process itself, this transition will also eliminate access to CMS’ MDS-based outcomes measures—the quality measures and quality indicators—that so many care providers rely on for quality monitoring and improvement.
 
In fact, CMS estimates that it may take one year before 3.0 measures and reports will be available.
That is why it is critical for leaders to recognize its significance and take a holistic approach that considers organizational structure, processes, and outcomes.
 
A successful transition needs to be orchestrated from the very top of the organization and driven by an interdisciplinary transition team that includes the facility administrator, director of nursing, dietitians, and the MDS coordinator, as well as representatives from therapy, social services, nursing, and the business office.

Opportunity To Rebuild

A successful transition team will understand the key role MDS plays in terms of a facility’s overall success and approach this project as an opportunity to rebuild the function internally. From a leadership perspective, this will require a broad look at the organizational structure, job descriptions, and chain of command to ensure that this transition team has the resources, access, and, most importantly, the authority to build a foundation for success.
 
To delineate responsibility for the implementation plan, consider creating teams for each MDS section. Each section team will document the current MDS assessment process, learn the MDS 3.0 requirements, and create a road map from 2.0 to the new 3.0 environment. Ultimately, this road map becomes the written action plan with detailed steps, accountability, and time frames for completion.
 
To get started, have section teams examine current source documents, tracking sheets, and notes used for MDS 2.0 to make sure they align properly with 3.0. Keep in mind that data-capture tools and strategies in place for meeting 2.0 requirements may not work in 3.0, and review all the data-capture tools carefully. Section teams will also present recommendations for possible resource reallocation and training needs.
 
During the implementation process, each section team should also recommend the appropriate MDS section facilitator. Ultimately, it is a section facilitator’s job to make sure that the assigned MDS section is completed accurately and in a timely manner. Facilitators are also responsible for ensuring multidisciplinary input. Too often, MDS access and input are limited to very few staff members, resulting in discipline silos where one person or discipline is “owner” of a section.
 
These silos produce resident assessments that are incomplete and less reflective of the resident’s actual status. For example, through conversation or observation, a social worker may obtain valuable input from the resident regarding pain or incontinence yet might be untrained in terms of presenting that input during MDS assessment or care plan meetings. This transition is an ideal opportunity to educate and train all caretakers on how to contribute their observations into the MDS assessment and improve the collaborative nature of care plan meetings.

Develop Interview Skills

Retraining will prove essential. At a minimum, two disciplines should be trained on each assessment section. Also, the development of new tools such as scripted interviews allows facilities to look beyond those currently responsible for assessing certain areas.
 
For example, while social services may be the traditional assessor for the mood section, access to scripted interview tools allows a facility to revisit this practice and consider other alternatives, and certainly more than one.
 
In any case, those selected to perform the interviews must be proficient and comfortable in that role. Accordingly, consider using resident council volunteers to help develop interview skills through mock interviews.
Plan now for potential obstacles, such as access to appropriate interview locations, how interviews will be scheduled into daily routines, and language barriers between staff and residents. Remember, interpreters are required when they are needed.
 
Beyond clinical resident assessments, the changeover to MDS 3.0 will have considerable impact on resident care planning, reimbursement, professional/general liability, public perception, and employee satisfaction.
While health care professionals have been down this road before, the key question is: “Are we doomed to repeat past mistakes, or will we use past experiences to master this impending challenge?” The answer is that with proper planning and effective leadership, every facility has the opportunity to implement MDS 3.0 with confidence and assurance of success.
 
Steven Littlehale, MS, GCNS-BC, is executive vice president and chief clinical officer, and Sheila Capitosti, RN-BC, NHA, MHSA, is senior health care specialist, at Lexington, Mass.-based PointRight, a company that provides information-based clinical management tools and services to providers, payers, regulators, suppliers, and consumers. For more information, call (781) 457-5900 or visit www.pointright.com.
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