MDS 3.0 – Becoming a Reality

October 1, 2010Presented to:

MDS 3.0 National Train the Trainer Conference April 12-15, 2010Baltimore, MD

Thomas Dudley, MS, RNCenters for Medicare & Medicaid ServicesOffice of Clinical Standards and QualityQuality Improvement and Health Assessment GroupDivision of Chronic and Post Acute Care

• An updated version of the instrument and manual will be published on the MDS 3.0 page of www.cms.gov in late May or early June.

• The taped version of this training conference will be published on www.cms.gov in late May or early June.

• Comments and questions can be submitted to MDS30Comments@cms.hhs.gov.

• The transition to MDS 3.0 is a TEAM effort and together WE will successfully make it through the change.

• Yes, the new MDS 3.0 instrument will be challenging at first, but keep in mind that MDS 2.0 was challenging at first. Change is hard, but change is good!

• “Perfect” doesn’t exist, we strive for perfection, but inevitably there will be hiccups. We all need to be patient as we work through the change together.

• History of MDS

• Why the Change to MDS 3.0? • MDS 3.0 Timeline

• MDS 3.0 Training – Now and Beyond

• Quality Measures and Public Reporting

• Simple answer: Because the law says so

• Omnibus Budget Reconciliation Act of 1987 is the • Statutory & Regulatory Basis for the RAI

• To provide a comprehensive, accurate, standardized, reproducible assessment of each resident's functional capabilities• To help staff identify health problems

• Balanced Budget Act (BBA) of 1997•Established the Skilled Nursing Facility (SNF) prospective payment system (PPS).

• October 1988 – Development of the RAI Began (HCFA established contracts with RTI, the Hebrew Rehabilitation Center for Aged, Brown University & the University of Michigan)

• October 1990 – Effective date for the RAI

• April 1995 – MDS 2.0

• April 1995 – Present – Instrument has remained relatively static

• Care Planning - December 1990 • Survey and Certification - December 1990

• Payment/Electronic Submission - June 22, 1998

• Nursing Home Quality Initiative/Public Reporting - November 2002 and the QIO Scope of Work

To make CMS happy? NO

To give NH providers something to do? NO

To give surveyors something to do? NO

To make sure providers are paid properly? YES

To make sure NH Residents are receiving appropriate care? ABSOLUTELY YES

To provide NH providers with a tool to assess the status of their Residents in order to appropriately develop plans of care to optimize quality of life? ABSOLUTELY YES

Why not?

MDS 2.0 is outdated

MDS 2.0 isn’t consistent with current clinical practices

MDS 2.0 has limited value to NH’s outside of it being a required assessment

Timeline

http://www.cms.hhs.gov/

SNF/LTC ODF www.cms.gov/OpenDoorForums/25_ODF_SNFLTC.asp

MDS 3.0 Website www.cms.gov/NursingHomeQualityInits/25_NHQIMDS30.asp

• Available ~May-June 2010

• To be available online 24/7, 365 days/year

• Exactly the same content that was available at the National Train-the-Trainer Conference

Will include Post Acute and Chronic Care Measures

New measures will replace existing measures (or at a minimum modify the existing measures based on the MDS 3.0 Instrument)

18 Candidate measures submitted to NQF

Ultimately the measures will be published on Nursing Home Compare

MDS 2.0 Quality Measures Recommended for Retirement/Replacement

PAC Chronic Potential Replacement

DeliriumX

Delirium (new PAC measure)

Mobility declineX

‘Ambulation’ (PAC and Chronic)

Pressure ulcers (low risk) XBedfast

X

Summary Table of 18 Measures Submitted to NQF for Endorsement

PAC ChronicFive-Star

Item

Percent of Residents with Pain X X X

Delirium (replacement measure) X X

Percent of Short-Stay Residents with Pressure Ulcers That Are New or Have Not Improved

X X

Percent of Residents Who Were Assessed and Given Pneumococcal Vaccination

X X

Summary Table of 18 Measures Submitted to NQF for Endorsement

PAC ChronicFive-Star

Item

Percent of Residents Who Were Assessed and Given Influenza Vaccination

X X

ADL decline (replacement measure) X X

Mobility decline (replacement w/ focus on ambulation)

X X

Percent of Long-Stay, High-Risk Residents with Pressure Ulcers

X X

Summary Table of 18 Measures Submitted to NQF for Endorsement

PAC ChronicFive-Star

Item

Percent of Long-Stay Residents Who Were Physically Restrained

X X

Percent of Long-Stay Residents Who Have/Had a Catheter Inserted and Left in Their Bladder

X X

Percent of Long-Stay Residents with a Urinary Tract Infection

X X

Summary Table of 18 Measures Submitted to NQF for Endorsement

PAC ChronicFive-Star

Item

Percent of Long-Stay, Low-Risk Residents Who Lose Control of their Bowels or Bladder

X

Percent of Long-Stay Residents Who Lose Too Much Weight

X

Percent of Long-Stay Residents Who Have Become More Depressed or Anxious

X

• Yes, October 1, 2010 is the implementation date.

• Yes, this applies to everyone.

• Yes, all of us will survive the change to MDS 3.0.

• Additional QMs

• Modifications to the MDS instrument to keep pace with changes in clinical practices

• MDS 4.0, Continuity Assessment Record and Evaluation Instrument (CARE), or EHRs?

General Comments or Suggestions can be submitted to:

MDS30Comments@cms.hhs.gov Or

Specific Questions can be submitted directly to me:

thomas.dudley@cms.hhs.gov