What are “The Big Changes” with MDS 3.0 and RUG IV?

Solid facility implementation strategies for the MDS 3.0 will affect multiple crucial areas of nursing home operations. Currently, MDS data drives quality of care outcomes as well as reimbursement for Medicare and Medicaid. How facilities use and validate this data will determine the future of successful regulatory, financial, and quality results. Implementation of the MDS 3.0 is scheduled for October 1, 2010. Focused changes in key operational and clinical systems are needed now to secure successful implementation that fosters resident-centered care, quality of life for residents and an ongoing, prosperous revenue stream.

Changes that Impact Reimbursement

  • New RUG-IV reimbursement system effective October 1, 2010.
  • Therapy Coding – CMS will require separate coding of individual, concurrent and group therapy minutes. 80% of your Medicare dollars today are driven by therapy. We expect under MDS 3.0, nursing will play a greater role and, so it’s important to study what’s coming and take steps to preserve precious therapy dollars.
  • Separation of services provided “While a resident…” and “While not a resident…” will significantly affect reimbursement
  • Interviews that impact a severity score:
    • Brief Interview for Mental Status (BIMS)- replaces the MDS 2.0 staff assessment for cognition and is a resident interview that measures cognition
    • Patient Health Questionnaire (PHQ-9) – replaces the MDS 2.0 Mood items and is a resident interview that screens for depression
  • Pressure Ulcers – elimination of reverse staging, information about pressure ulcers on admission, utilizes the PUSH tool, and new item includes pressure ulcer risk and utilization of a formal assessment tool/system. Stage III and Stage IV, as well as the ability to group multiple wounds drive higher reimbursements. Capturing this information with MDS 3.0 is much more technical, and providers need to be adequately prepared.
  • Multiple New Assessments – 3 new OMRA’s, Entry and Death In Facility records, Discharge Assessments, and Short Stay Assessment

Changes that Impact Quality Outcomes

  • Confusion Assessment Method (CAM) – replaces the MDS 2.0 items for Delirium
  • Behavior item changes with added “impact” focus.
  • Interviews that impact quality:
    • Pain Interview – Treatment items added, interview captures resident’s effect of pain on sleep and day-to-day activity
    • Customary Routine, Activities, and Community Setting – resident interview with focus on “choice” and “can’t do” items
    • Brief Interview for Mental Status (BIMS) – replaces the MDS 2.0 staff assessment for cognition and is a resident interview that measure cognition
    • Patient Health Questionnaire (PHQ-9) – replaces the MDS 2.0 Mood items and is a resident interview that screens for depression

Want to learn more? Link to my full white paper on this topic:

http://bit.ly/9mH1u4

Posted by: Lisa Hohlbein RN, RAC-CT, MSCN
Manager of Clinical Consulting