Will MDS 3.0 and RUG-IV Continue to Be Moving Targets? Yep…

As October 1, 2010, is approaching, we are learning how the Centers for Medicare & Medicaid Services (CMS) will handle the RUG-IV delay resulting from the passage of the Health Care Reform Act. During the May 3-4 American Association of Nurse Assessment Coordinators (AANAC) Conference in Las Vegas, Nevada, CMS announced they will pay claims beginning October 1, 2010, utilizing the RUG-IV grouper until they have completed and tested a new, hybrid RUG-III grouper. At such time, the Medicare Administrative Contractors (MACs) and Fiscal Intermediaries (FIs) will be expected to reprocess all claims using this new RUG-III grouper and pay providers accordingly. (CMS has been phasing in MACs to eventually replace the FIs. Right now, both exist.) Presently, there is no prescriptive formula to forecast the financial impact of the new, hybrid grouper.

What is Six Sigma?

Six Sigma is one example of a quality methodology that assists with process improvement initiatives. From a statistical perspective, Six Sigma is a measure of variation. A process is said to be “Six Sigma” when it yields no more than 3.4 defects per million opportunities. To put that in perspective, suppose there is an invoice entry process whereby a manual entry is required. That would mean only 3.4 manual entry errors per million manual entries!

What does “meaningful use” mean for post-acute healthcare?

Admittedly this is an unfair question in the moment because there isn’t an answer yet! We have, however, seen CMS’s initial definition of meaningful use for hospitals and to describe it as invasive is not an exaggeration. At a recent meeting of hospital CIOs a key point was driven home; the doctors must have “hands on keyboards”, not simply dictate or provides notes to others for entry into an EHR system. This mandate suggests not only the capturing of information as a requirement, but also changes to the workflows surrounding the data capture. The hospital CIOs agreed that implementing the technology in their companies was much easier than ensuring the clinical staff adopted the technology and adjusted their workflows accordingly. In other words, implementing an EHR solution is a business challenge which includes a technology component, not an IT project.

MDS 3.0 and RUG IV: Are You Ready??

Even though the MDS has been used for more than a decade, it continues to be re-tooled. Now, seventeen years later, the MDS 3.0 and RUG-IV are scheduled for implementation in October, 2010. With roughly a half year left before this major change, we find ourselves wondering what needs to happen to assure success. Let’s look at the process from 10,000 feet.