It’s been over a year since nursing homes began implementing – and enduring pain points – in the transition from Section G to GG in the Minimum Data Set (MDS), but efforts to address the initial troubles seem to be paying off.

The challenges of incorporating the changes to MDS came with higher administrative burdens amid a staffing crisis, leading nursing homes to log in more precise documentation. In the end, the workarounds improved staff efficiency, interdisciplinary team collaboration, understanding of functional definitions among staff, and compliance with federal regulations for some operators. By now, these operators report that the administrative burdens stemming from the change are mostly manageable too.

Heather Haberhern, SVP of quality at Health Dimensions Group (HDG), Jody O’Mara, chief nursing officer at Journey and Danielle Dang, VP of clinical reimbursement at EF Senior Care, who all spoke at Skilled Nursing News’ CLINICAL conference recently, said that while they hadn’t noticed changes in care delivery at their companies, the MDS shift has given staff more clarity on certain tasks.

The most immediate effect of the MDS transition is on the documentation process. The shift from 10 items in Section G to 29 in Section GG has forced caregivers to break down tasks into more granular components.

Now, instead of just coding bed mobility, staff now need to document a variety of activities, such as “sitting to lying” and “rolling left and right,” said Haberhern. This change demands a higher level of understanding of functional definitions from caregivers, ensuring that tasks are accurately documented for each resident’s performance. While this does not significantly alter the quality of care, it requires caregivers to spend more time analyzing and recording detailed functional tasks.

“The caregiver is [better] able to analyze what’s actually happening with the resident and their level of function,” said Haberhern.

As a result of the shift, O’Mara acknowledged that nurse aides are having to spend more time documenting compared to before – and for many it’s still a difficult adjustment.  

That said, more documenting, while onerous, has meant a silver lining, she said.

“There’s much more collaboration with therapy and the interdisciplinary team now – there has to be for setting the goals,” O’Mara said.

Workarounds 

However, the process of adapting to these changes has not been without challenges. Initial implementation took considerable time, especially as staff needed to adjust to new definitions and procedures.

“We’ve seen our nurses doing more documentation for GG than our caregivers. Our CNAs are doing less documentation for GG and point of care documentation,” said Haberhern.

And so, HDG facilities have slimmed down some of the templates used for documenting clinical findings as well as the time spent in conducting resident interviews, she said, which has led to some efficiencies.

“Now, we put them all on one one assessment so we capture everything at one time, instead of multiple people coming in to do the interviews for the resident,” said Haberhern.

For EF Senior, a few simple techniques are also helping beat the workload from the extra documentation.

“One of the things we did around the education is that we made little cue cards for the new six points, and put them on the back of [employee] tags,” Dang said.

Also, extra training in multiple languages was provided using translated cue cards for the six points as well as training in different languages.

“You may not realize it, but a lot of the platforms do offer some of those basic training in other languages, and [language] is often the barrier to success,” Dang said.

Collaboration across teams

One of the key positive changes driven by the MDS transition has been the increase in interdisciplinary collaboration.

The GG assessments almost make it necessary to involve members from across different teams to ensure accurate coding, operators said. Nurses, therapists, social workers, and other team members must communicate regularly to agree on a resident’s functional status.

At both Journey and HDG, this has led to the establishment of regular GG meetings after morning stand-up sessions, where interdisciplinary teams come together to discuss residents’ performance and ensure that all disciplines are aligned in their coding.

“We started with PDPM huddles, and then we’ve moved to GG meetings, where after our morning stand up meeting, and we actually discuss any residents that have GG that needs to be coded, whether it’s for the OBRA assessment or for Med A [inpatient treatments],” said Haberhern. “It has really, truly brought the teams together.”

At these GG meetings, teams address the resident’s usual performance and code together.

“So, it’s not just a therapy thing. It’s not just a nursing thing. Social services is involved as well, and so it’s really brought the team together to actually have discussions about what the residents are able to do and to code that accurately and appropriately,” she said.

The increase in collaboration is not without challenges. Different disciplines often use different terminology and have varying perspectives on what constitutes “usual” performance. For instance, therapy staff may focus on specific functional movements like bed mobility, while nursing staff may be more focused on the overall care needs of the resident.

To bridge these gaps, teams at Journey have developed crosswalks and shared review processes to ensure that coding is consistent across disciplines.

This effort has helped to reduce discrepancies and improve the accuracy of MDS coding, which directly impacts regulatory compliance and reimbursement rates.

MDS Shift forces earlier interventions

Although the new requirements have created additional documentation tasks, the transition has also led to better observation of residents – and earlier interventions – in turn improving care, according to Dang.

“The whole process has enhanced nurse and caregiver efficiency, in a way, because we’ve given them a number of things to basically target focus areas in patients and notice those changes in that resident,” she said.

At EF Senior Care, nurses are required to interact, stop and watch, and rank patients that are potentially more acute or trending in the sick zone, and then prioritizing their care.

“[The shift] has just opened up different ways to capture that information and improve patient care by early intervention,” Dang said.