New MDS 3.0 regulatory changes are here: Is your SNF ready?
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The new MDS 3.0 regulatory changes will have a major impact on skilled nursing facilities (SNFs). Ever since the draft version of MDS 3.0 v1.18.11 was released in September 2022, leaders across the long-term care (LTC) industry have been scrambling to prepare.
In this post-pandemic era of short staffing and evolving regulatory changes, it’s more challenging than ever to get MDS reporting right. And with the comprehensive changes to MDS 3.0 now in effect, SNF leaders will have their plates full trying to adapt to the shifting landscape beneath them.
This significant update to MDS 3.0 will require intense effort on the part of SNFs to ensure data accuracy and avoid pitfalls throughout the transition.
Ensuring the accuracy of your MDS data is essential to so many critical aspects of your operations, such as:
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- Keeping your 5-star rating — so you can remain competitive in today’s market
- Staying compliant – to avoid fines and financial penalties by state and federal agencies
- Maximizing reimbursements — by using accurate MDS data to decrease errors and help increase deserved reimbursements, as well as identify additional potential revenue
What is MDS 3.0?
The MDS assessment serves as an important tool for developing individualized care plans, tracking resident progress over time, and monitoring quality performance.
According to CMS, MDS 3.0 was implemented in 2010 to address concerns from residents, families, providers, researchers, advocates, stakeholders, and policymakers about the “reliability, validity, and relevance” of MDS 2.0.
“Some argued that because MDS 2.0 failed to include items that rely on direct resident interview, it failed to obtain critical information and effectively disenfranchised many residents from the assessment process,” CMS says. “In addition, many users and government agencies expressed concerns about the quality and validity of the MDS 2.0 data. Other stakeholders contended that data elements used in other care settings should be included to improve communication across providers.”
What is the MDS used for?
Of all the documents your facility completes, the MDS is the most powerful with the greatest impact. It is used to:
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- Provide residents with a voice and choice in their care
- Enable person-centered care planning based on the resident’s strengths and needs
- Inform discharge planning
- Measure the quality of care
- Enable assessment of the facility and staffing levels
- Determine reimbursement for care and services
- Assess compliance with federal and state regulations
- Determine future incentive payments for improving quality of care through the Skilled Nursing Facility Value Based Purchasing (SNF VBP) Program
- Drive a facility’s star rating which helps consumers make care decisions between competitors
- Support a legal defense against lawsuits directed at the facility or specific staff members
- Inform research
- Support provider communications
- Drive payment under the PDPM program
What kind of information is in the MDS?
There is a wealth of information in the MDS. Each major section includes detailed data points that are coded to reflect the resident’s status regarding various aspects of function, cognition, mobility, behavior, symptoms, diagnoses, medications, and much more.
Titles of major sections in the new MDS 3.0 specific to the resident include:
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- Section A: Identification
- Section B: Hearing, Speech, and Vision
- Section C: Cognitive Patterns
- Section D: Mood
- Section E: Behavior
- Section F: Preferences for Customary Routine and Activities
- Section GG: Functional Abilities and Goals
- Section H: Bladder and Bowel
- Section I: Active Diagnoses
- Section J: Health Conditions
- Section K: Swallowing/Nutritional Status
- Section L: Oral/Dental Status
- Section M: Skin Conditions
- Section N: Medications
- Section O: Special Treatments, Procedures, and Programs
- Section P: Restraints and Alarms
- Section Q: Participation in Assessment and Goal Setting
- Section V: Care Area Assessment (CAA) Summary
What is the new compliance regulation effective October 1?
When experts across the LTC industry reviewed the draft version of MDS 3.0 v1.18.11 that was released last fall, many expressed concern regarding the daunting task ahead.
As one expert said, “Providers should regard this change to the MDS as the most significant since the implementation of MDS 3.0. The sheer volume of new data that providers will be required to collect in MDS Version 1.18.11 starting in October 2023 is significant and will require much in the way of preparation. To prepare seven full pages of additional items to begin coding is no small task. Procrastinators, beware.”
And although the changes may seem overwhelming, there are silver linings, too — such as the ability to see greater uniformity among settings across the continuum of care, and the opportunity to help “resident voices to shine,” as another expert said.
Five significant MDS changes that became effective October 1
Of all the updates included in this MDS 3.0 version, there are five changes providers most need to understand.1
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- Elimination of Section G (Functional Status) and transition to Section GG (Functional Abilities and Goals)
- Collection of additional social determinants of health data
- Documentation for indication of use for medications
- The release of the Optional State Assessment (OSA)
- Additional questions at discharge about the transfer of health information
Discover MDS Intelligence
In the midst of such rapid regulatory change, the good news is that Inovalon’s MDS Intelligence data-driven software solution can help.
With MDS Intelligence, you can leverage actionable, data-driven insights to earn higher reimbursements, improve outcomes, and simplify quality management.
At your fingertips, you will have access to user-friendly tools to enhance survey preparedness and submit more accurate MDS assessments and cleaner claims. Inovalon’s streamlined Triple Check process optimizes PDPM payments, reduces the risk of federal tags, and monitors SNF star ratings in real time.
Navigate a changing regulatory landscape and steer your organization’s quality performance in the right direction with easy-to-use skilled nursing software that offers:
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- Real-time quality performance monitoring
- A QM Benchmark dashboard to track performance
- Automated data collection and reporting processes
- A PDPM calculator to predict and optimize revenue
Benefits for your organization
MDS Intelligence makes MDS management easy – and effective. Powerful clinical analytics not only enable SNF organizations to ensure data integrity and accuracy, but also draw insights from their MDS data to improve resident care and financial performance.
And when it comes to return on investment, MDS Intelligence provides:
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- Time savings by reducing the number of manual reports required to operate your facility
- Improved efficiency with a dashboard to help you focus on priorities, simplify processes, manage caseloads, and view data inaccuracies with just three clicks
- Revenue optimization with a display of MDS data analytics to identify overlooked opportunities
As a result, you can spend less time on administrative tasks and more time on care – the way it should be.
Enhanced MDS accuracy
With advanced SNF data analytics and real-time quality performance monitoring, you’re notified of inconsistencies before MDS submission. Logic flags alert you when there are changes from assessment to assessment.
Daily revenue projections
Identify opportunities to improve financial performance with MDS software that offers real-time, actionable insights. Monitor financial impact with a built-in PDPM tool that projects revenue for each day of a resident’s stay.
Better regulatory compliance
Align your processes with the latest regulatory requirements, ensure clinical data is consistent with the care provided, spot risks for federal tags, quickly identify errors for resolution, and boost survey preparedness.
Quality measure benchmarking
Track, trend, and monitor quality measures and SNF star ratings with reports and charts that show how your facility is performing in comparison to federal, state and other MDS Intelligence facilities.
Improved SNF resident outcomes
Access historic and current patient-level data to monitor clinical status and identify interventions to improve care, quality of life, and resident outcomes.
At Inovalon, we help skilled nursing facilities make more informed care decisions, maximize reimbursements, enhance star ratings, monitor performance, and stay compliant.
Sources:
- “5 major MDS changes – October 1, 2023,”AAPACN. April 3, 2023.
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