The Clock is Ticking Towards MDS 3.0 By Cynthia Fronning, RNC, CDONA, RAC-MT

At the end of January, the Centers for Medicare and Medicaid Services (CMS) held an Open Door Forum to review the draft MDS 3.0 and share the results of the completed field study. 0ver the next 17 months, MDS 3.0 will be finalized, the Resident Assessment Instrument Manual (RAI manual) will be rewritten to contain the updates, software vendor specifications will be released and provider instructions will be distributed. Additionally, the necessary adjustments will be made to the Medicare RUG system.

The draft MDS 3.0 was tested in 71 nursing homes in 8 different states. CMS continues to emphasize that this is a “draft” document. Revisions, additions and deletions are very possible and the final MDS 3.0 may change from this current draft.

Driving the MDS 3.0 is the process of “Obtaining the Resident’s Voice”. This will be accomplished through resident interviews in order to identify the resident’s perception of their pain, functional, cognitive and emotional status.

Many areas on the assessment form have changed, for example:

§         Look back time frames have been shortened.

§         Sections have added more questions, others have been combined and questions have been moved from one part to another.

§         If able, resident interviews are incorporated into the MDS format

§         Coding definitions have changed. An example is section G (ADLs). Instead of coding how frequently assistance was provided, the new code asks for the most dependent episode in the past 5 days. The definitions in this section have also changed, combining column A and Column B from the MDS 2.0 to form a single response scale.

§         Reverse staging of ulcers has been eliminated in Section M.

Overall, the nurses who completed MDS 3.0 have a high satisfaction rate, stating that they believe that MDS 3.0 has increased clinical relevance, improvement in clarity, better knowledge of the resident related to the interview process and decreased time to complete the MDS.

Click here to review the “draft” MDS 3.0: http://www.cms.hhs.gov/NursingHomeQualityInits/25_NHQIMDS30.asp

The CMS MDS 3.0 Timeline for 2008 is as follows:

§         MDS 2.0/MDS 3.0 Crosswalk to States, Providers and Vendors, Spring 2008

§         MDS 3.0 Transition Plan to States, Providers and Vendors, Spring 2008

§         Draft MDS 3.0 Specifications to Vendors and Providers with preliminary Staff Time

      Resource Intensity Verification (STRIVE) changes, November 2008

Early 2009 events:

§         Final MDS 3.0 Specifications with STRIVE Changes to Vendors and Providers, February 2009

§         State Medicaid National Meeting MDS 3.0 Presentation, March 2009

§         RAI and Technical Conferences: State Survey, Medicaid & Automation Staffs, Spring 2009

 If you are an Administrator or a DON, you should be asking yourself the following questions:

• Do we have the necessary interviewing skills among current team members and how can we determine this?
• Will our software vendors be updating our current software or will we need to purchase new software?
• Who will lead the charge for monitoring and implementing this change in our facility?

The time to start discussing and planning is now. Gather your team and begin reviewing the MDS 3.0 draft document to identify what the changes are and how they will affect your facility. An informed facility and staff will ease your transition to the new process!

Things that you can do today:

• Start talking to your vendors. Express your needs and find out what the vendors are considering.
• Keep abreast of current information and additional changes as they are released.
• Register to participate in Pathway’s teleconferences coming in March.

Do you have any questions about the new MDS process? Please submit them to consult@pathwayhealth.com and have them answered by a Pathway professional. Questions will be answered in the next Pathway Perspectives newsletter on March 19, 2008.