MDS is a tool for implementing standardized assessments and for facilitating care management in nursing facilities and noncritical access hospital swing beds, according to CMS.

This core set of screening and assessment elements appears as a comprehensive, lengthy form, which includes common definitions and coding categories. MDS 3.0 is meant to be the basis of a nursing facility resident’s overall assessment. 

Its content has implications for residents, families, providers, researchers, and policymakers, all of whom expressed concerns about the reliability, validity, and relevance of its precursor MDS 2.0, CMS said. 

2.0’s Weaknesses

Some contended that because MDS 2.0 failed to include items that rely on direct resident interviews, it did not obtain critical information and disenfranchised many residents from the assessment process. In addition, many users and government agencies expressed concerns about MDS 2.0 data quality and validity. Other stakeholders said that items used in other care settings should be included to improve communication across providers.

The design of MDS 3.0 aimed to improve its reliability, accuracy, and usefulness to include the resident in the assessment process and to use standard protocols across settings. “These improvements have profound implications for nursing home and swing bed care and public policy. Enhanced accuracy supports the primary legislative intent that MDS be a tool to improve clinical assessment and supports the credibility of programs that rely on MDS,” the agency said.

Effort Ramps Up

The shift to MDS 3.0 has taken place in earnest over the past few years. On Oct. 30, 2009, CMS released the “Resident Assessment Instrument (RAI) Users Manual V 3.0” that included MDS 3.0. The mandatory assessment tools went into effect for all Medicare-certified skilled nursing facilities on Oct. 1, 2010. 

In conjunction with MDS 3.0 came the Resource Utilization Group (RUG) IV payment system. RUG IV added new categories and adjusted payments higher for treating clinically complex nursing facility residents.

RAI came to be in the late 1980s when in 1987 the Nursing Home Reform Amendments, or OBRA, became law. RAI 3.0 is now part of the MDS 3.0 transition.

The progression from the 2.0 versions of MDS and RAI has seen a number of major revisions, adding assessments for depression, pain, and falls, among others. The main accomplishment for MDS 3.0 has been the inclusion of resident feedback in the form of interviews, as well as the ability for providers to file the assessments electronically.

Skin tracking parts of MDS 3.0 are also greatly expanded from the previous version, under Section M in the document. This has brought more attention to pressure ulcers and the prevention and care of the all-too-common condition.

Better Data The Goal

According to the Rand Corp./Harvard review of the MDS 3.0 effort, the revision to the MDS system was “aimed to improve the clinical relevance and accuracy of MDS assessments, increase the voice of residents in assessments, improve user satisfaction, and increase the efficiency of reports.”

Rand/Harvard conducted a thorough assessment of its own on the early MDS 3.0 trials, coming to the conclusion that improvements incorporated in MDS 3.0 produced a more efficient assessment as well as better quality information in less time. 

“Including items recognized in other care settings is likely to enhance communication among providers. These significant gains reflect the cumulative effect of changes across the tool, including use of more valid items, direct inclusion of resident reports, improved clarity of retained items, deletion of poorly performing items, form redesign, and briefer assessment periods for clinical items,” Rand/Harvard said.