While the demand for nursing home MDS coordinators has always been higher than their availability, some organizations are beginning to see fruits from concerted efforts to stabilize this specialized role.

MDS coordinators ensure accuracy of minimum data set (MDS), which in turn is evaluated by surveyors. With brand new survey changes going into effect Monday and generally stricter regulations over the course of the last few years, facilities have had their hands full in ensuring compliance.

Virtual visits by MDS nurses, float pools, nurses on an as-needed basis, and agency staff are some solutions facilities have deployed to address the shortage of MDS coordinators. Some nursing homes have also used interim MDS coordinators or leveraged technology to enlist remote support – especially in rural areas facing severe staffing shortages.

In the end, however, all facilities aim to have the assistance of in-person, non-temporary MDS coordinators. After all, the task at hand requires a mastery of codes and deep knowledge of resident care needs. And so, with an ever-increasing burden from regulations, operators are being proactive. 

At Indiana-based Journey Skilled Nursing, even though all open MDS coordinator positions are now filled, leaders admit it’s a constantly evolving situation that requires ongoing attention to solutions, not only to prevent compliance shortfalls but also erosion of revenue. 

“The MDS becomes harder and harder – it’s been kind of a needle in the haystack,” said Laurel Lingle, VP of Talent Acquisition at Journey.

There has been the added pressure to allow remote access and more flexibility to prevent burnout of workers as well, she said.

“More people are wanting to work remotely … And those are things we’re not providing right now, but we’re seeing the demand, so we’re having to kind of look at everything and see what we’re going to do to get those positions filled,” Lingle said.

Journey operates 22 facilities across six states.

Still, Journey’s success aside, ramping up the number of MDS specialists remains on the wishlist of many facilities and is a constant battle. For this reason, some larger regional organizations have put in place some proactive measures that don’t deplete the MDS coordinators below a certain level.

Monarch Healthcare Management, for example, has over the last few years developed a very advanced system of managing its MDS coordinator pool so that it’s stable and adequately staffed. Although the struggle wasn’t new, the crisis hit a low point predictably during the Covid-19 pandemic.

This is according to Tracy Cloud, director of clinical reimbursement at Monarch, who oversees all things MDS, including recruiting, retaining and charting duties for MDS coordinators. She joined the organization in the summer of 2022, and during Cloud’s tenure, the organization has grown its MDS staff from 27 MDS coordinators to a steady group of 50.

Monarch has 45 nursing homes throughout the state of Minnesota, and 17 assisted living facilities, with locations in urban and rural communities.

How to grow the MDS team 

Like many nursing home operators, after the pandemic Monarch too faced challenges in balancing staffing roles and improving processes. And initially, not unlike many of its counterparts, Monarch only hired registered nurses (RNs) for the MDS coordinator role, Cloud said. However, she advocated for hiring licensed practical nurses (LPNs) as well, believing it would provide more flexibility and help fill positions. And this helped grow the numbers of MDS coordinators.

Monarch also worked to eliminate unnecessary duties for MDS coordinators, like being on call or handling medication carts, which could be done by CNAs instead.

A key focus for Cloud was improving education and training for MDS coordinators as well as preventing burnout. Over time, Cloud successfully pushed for better training programs and cultural changes, emphasizing that education was critical to success. Monarch also built an MDS team from within the existing staffing pool to help with training and to promote from within the organization.

“I’m trying to change the culture. And we’re moving in the right direction, but with any culture change, it takes time and information,” Cloud said.

Leaving money on the table

A poorly managed system may not always get operators in compliance trouble, but facilities can really increase reimbursement if MDS coordinators are left to perform their duties as MDS coordinators, and not be distracted with duties such as pushing medication carts, said Cloud.

Cloud allowed her MDS staff to fully dedicate themselves to the MDS coordinator role, handling processes like Patient-Driven Payment Model (PDPM), quality measures, accuracy, scheduling, and overall management. In doing so, she learned the importance of time and training to transition staff from a limited coding role to a broader, more responsible coordinator role.

Cloud describes her approach as “proactive” in implementing changes such as she did with the transition to the PDPM while she was still working with a skilled nursing organization in Florida. At her old employer, she helped the director of rehab organize year-round training and introduced PDPM processes three months before the official rollout. This preparation led to strong performance, with reimbursement rates exceeding expectations by $69 per resident, she said. 

It was a program Cloud carried with her to Monarch, its cornerstone being education and preparation, she said, noting that inexperienced MDS staff can’t be expected to succeed without proper training and support.

Not resting yet

But reimbursement benefits aside, nursing homes will need to tackle mounting regulation and compliance checks – the latest in the form of survey changes effective April 28 – and shift from section G to GG, already in effect since last October. 

The MDS transition from Section G to GG has increased the burden of documentation, leaders at Journey said. The shift from 10 items in Section G to 29 in Section GG has forced caregivers to break down tasks into more granular components.

And while MDS coordinators are more sought after than ever, operators who are proactive with training and prevent burnout will find the exercise difficult, but fruitful in the end, leaders said.

Like Journey, Monarch has no agency-based MDS coordinators currently. Instead it’s a steady group having doubled its MDS coordinators thanks to the changes Cloud made.

Now, Monarch has three regional MDS specialists and each of them is responsible for providing support, training, education, and auditing for about 11 to 12 facilities. Two of them are currently covering 12 facilities each.

With more regulation on its way, Monarch is prepared.

“Minnesota is moving away from their case mix structure, moving towards PDPM structure. And so right now, our CNAs are still documenting on Section G and our IDT does the GG piece. We’re moving away from that now. We’re going to have to train, and we’re going to do what I call a ‘road show.’ Me and my three MDS specialists are going to just take a couple weeks and go to each facility and do trainings with CNAs on documentation for GG,” Cloud said.

And at Journey, Lingle is vigilant too.

“I can knock on wood. We filled our last [open MDS position] last week, so we are 100% filled in all of our MDS roles right now. We hope it stays that way, but we foresee some changes coming with the new regs and the demand for that position as well,” Lingle said.