More than a week after updates to the Minimum Data Set (MDS) went into effect, each section change seems to be emphasizing focus on the resident’s voice, which along with substantial coding changes – four years in the making – will require time to incorporate, experts said.
Kevin Cezat, director of clinical excellence for Therapy Management Corporation (TMC), walked nursing home operators through section changes in a webinar held by the consulting group on Tuesday. He noted that changes to Section A, for example, require that the patient’s preferred language be clearly indicated in the plan of care, and through the medical record for all staff members to understand.
Meanwhile, Section B prompts staff to focus on health literacy by keeping with scripted interviews as much as possible, not rushing the resident in responses, breaking longer questions into parts, waiting for a reply and maintaining eye contact.
All of these changes translate to a lot more time for direct interviews and information gathering, said Cezat.
Along with calling attention to this increased “resident voice focus,” Cezat went over the details of the updates with Section G to GG, while also touching upon changes for Sections A through X. He shared useful steps providers can take to incorporate the changes more efficiently.
“It will take some time for our staff to get comfortable with these coding levels,” said Cezat. “I think in conjunction with some ongoing training, we’ll also need to provide them with a lot of the cheat sheets or algorithms that can really help teams get used to coding GG items accurately.”
These changes have been a long time coming, with the Patient Driven Payment Model (PDPM) being added in 2019. However, the public health emergency stalled MDS changes from PDPM until this year.
“Because of that four year gap, we now find ourselves with an MDS change that is fairly significant. Some people argue the biggest change since 2010,” said Cezat.
Steps providers should take now, he said, include assessing current policies and procedures. This is a way to make sure data collection supports new and revised MDS data elements. And, he told providers to be aware that training team members will be an ongoing process beyond the first of the month.
Moreover, a “gap analysis” would be helpful too, to identify any changes needed for current documentation tools utilized in MDS coding.
And, as for changes beyond those related to coding, Cezat also suggested operators review state specific Medicaid case mix index (CMI) requirements.
Some states will be continuing with Section G via the optional state assessment (OSA), while others have or are making the switch to PDPM this month.
“Reach out to your state Medicaid agency or your RAI coordinator for any of your unanswered questions,” he noted.
Other considerations highlighted during the webinar include a new GG self-care item, personal hygiene, and new GG mobility item, tub or shower transfer. These items will not be collected for Medicare Part A assessments, he said, unless combined with an Omnibus Budget Reconciliation Act (OBRA) assessment.
“Each GG item has a distinct coding window for each assessment type. Keeping the collection windows straight and making sure they’re collected in the appropriate timeframes become significant,” added Cezat.
Section GG is used to evaluate a resident’s self-care and mobility.
The functional limitation in range of motion and mobility devices will be collected in the Medicare 5-Day and all OBRA assessments, he added.
Another tip provided by Cezat included the advice that operators should change their approach for managing assessment reference date (ARD) documentation collection windows for each type of assessment, Medicare and non-Medicare.
There are unique requirements for each assessment, he said, and missing the opportunity to document in the required window could mean not capturing resources needed for quality measures, the SNF Quality Reporting Program (QRP) the Five-Star Rating System, or PDPM reimbursement.
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