We had our annual Medicare/Medicaid Certification Survey last week.
The survey team cited 278 - Accuracy of assessments because 4 items were coded incorrectly. 3 residents were involved.
ERROR #1: Resident A used full side rails but it wasn't coded under the restraint section P4a instead was coded correctly under G6b.
ERROR #2: This same resident had P1o checked since she was a hospice patient but staff neglected to check J5c.
ERROR #3: Resident B had P1o checked since he was a hospice patient but staff neglected to check J5c.
ERROR #4: Resident C used a chair that prevented rising on 2 occasions during his assessment period, but staff failed to code this under P4e.
I am upset - the survey team expects perfection in MDS coding - they could not identify any outcome related to this miscoding, but stated the regulations demand 100% perfection. My calculations were that 7500 boxes needed to be completed for residents A, B, C, D and E during the last 3 quarters. The survey team found 4 items miscoded out of 7500 - an error rate of 0.5%....less than 1%!
Our facility completed 354,048 MDS boxes during this period - it is inconceivable to me that the survey team expects perfection in this area!
Have your survey teams taken this hard core stance? PLEASE let me know if this seems reasonable to you or if you have experienced a similiar problem with the survey team. HELP>>>HELP!
Mar 26, '01
Sorry Km...please refer to Suzy's post. This is why I am an LPN. I deal with patients...not boxes. LOL LOL LOL
Mar 26, '01
With the new MDS structure, they will know EVERYTHING they need to know about your facility before they even get there.
The sad thing is, they got so involved in chasing down fraudulent NHA's, & RNAC's, that they have taken an entire RN [in some cases an RN/LPN team or a few RN's, depending upon facility size], to make sure paperwork is done correctly. Medicare/Medicaid survey's have gotten right out of hand. Now, with the new attestation that the RNAC's have to sign---GOOD LUCK finding an RNAC. This is the main reason I don't practice as an NHA.
I predict that this trend will get worse, and monetary penalties will be assessed if errors are detected in key CMI-generating items. It is probably only a matter of time until criminal prosecutions ensue.
Take care of yourself, "CYA" and good luck.
-How far that little candle throws his beam... So shines a good deed in a naughty world.
Mar 27, '01
i do emphatize with you.
it's unfair for these surveyors to site you on the basis of just a small percentage of inaccurate coding. they should have a standard criteria for
inaccurate MDS coding citation.
why don't you file an appeal?
because of the nationwide shortage of nurses, RNAC and assessment nurses are called to assume other responsibilites.
most of us are losing our vision, developing CTS, stress related conditions just
keeping us with paperwork
we believe that quality of life of the patients we serve is much more important than this.
Jun 17, '01
What was the scope and severity of the cite? I have seen surveyors cite this as an "A" meaning no harm came to the resident. It's more like a slap on the hand to be more careful. I don't know how many other deficiencies your facility was cited with but sometimes a survey team will find something wrong just so the federal surveyors don't come in behind them. THEY HAVE NO MERCY WHAT SO EVER!
Jul 9, '01
I am currently an LPN assessment coordinator. I will be entering my 2nd year in an RN program in September. My increasing frustration and fear of penalization for such ridiculousness has caused me to rethink my career track. I am tired of jumping through hoops to satisfy these regulatory people who have so lost touch with the real purpose of nursing.
I can identify with your anger and frustration. Your statistics speak for themselves. It is too bad that facilities feel that appeals are not worth setting themselves up for further target practice by surveyors in the future. The appeals process in our state is a joke as the persons reviewing the appeals are the supervisors of the very surveyors that cited the deficciencies! There should be a review panel independent of the survey teams. It is hard not to become pessimistic isn't it?
Jul 10, '01
Thanks for your kind replies!
Our state survey agency believes that every regulation demands perfection. As such, they cite anything they see regardless of what you can show them from a QI perspective. They say that although you will be cited, the severity will be low, hence...you shouldn't care. However, they narrow the population to increase the scope of the problem whenever they can.
It is frustrating to live in a border city and know that the facility 5 miles away in another state would not be cited for the same issues.
Our state believes that they are doing everything correct and the other states are under-citing.
Jul 11, '01
*Singing* I'm so glad I'm a Canadian nurse...........LOL!
Sep 14, '01
I am sorry to hear about your deficiencies but the same holds true in NC. Maybe this can be taken as a learning experience. What the MDS Coordinator has done here was to initiate care plan rounds with the CNAs and Nurses to ensure when the person was care planned or the mds/raps was update, it correlated with the patient. I think sometimes in doing the paperwork we can get comfortable with the word of one person. It is best to make sure the nurse's notes and other interdisciplinary team members' notes verify what was put in the care plan. It is hard to fight a def. when the care plan says one thing and everyone else on the team says something else. Good luck. I feel your pain.
Oct 16, '01
I am a RAI Coordinator in Missouri. I think the best thing for MDS Coordinators are to have developed mini QA programs within the sections of MDS. Our facility has 300 residents. At this time we do not have Medicare residents (PPS). We have 3 RAI coordinators for each floor (100 residents a piece)!
We have developed several programs. We keep track (monthly) who has restraints, who has what kind of side rail-down to even what kind of rail type is on their bed regardless if they use rails or not. You have to have QI programs on all Sentinel Events ( dehydration, low risk pressure ulcers, and fecal impaction) Have a standard protocol on how you keep track of these items when reviewing charts. We keep track of risk factors for Pressure ulcers -using the Norton Assessment. We also have developed protocols for restraint use, residents at risk for dehydration and residents which are considered High fall risks. We monitor these residents Monthly and document. We keep an ongoing log of all our residents infections for the month etc. You have to do this to be accurate in fed and state reg eyes. You will find that you know your residents so well- you wont be worried if you get cited if you cover all your bases. Just remember! Careplan , Careplan,Careplan!!!!! That is what they look at the most-and making sure you have good communication with your direct staff-so that everyone is on same page. We have mini careplans for CNA staff, they update the CP 1-2 weeks prior to Careplan day, that keeps us more informed about behaviors, decline, abilities etc. It really helps. Also gives information on how they can best take care of the residents -especially if you have a new CNA-and we all know how they come and go. Good luck-email me any time if you have any questions-been doing this for 4 years and counting! In Missouri.
Oct 17, '01
Hi KmRn, I feel your pain, even though i am an L.P.N. i have been the brunt of this. No one is perfect and a citation for a box check is kind of extreme. Certification time used to give me the biggest headach of the year. After doing your job well all year they come in and nitpick with things. Well there are some other things they should know, for instance the way administration handles things the rest of the year,and only get it in gear when they know they are coming WELCOME TO A LITTLE CORNER FOR CAREGIVERS
Oct 17, '01
I posted recently under the JCAHO heading because even though I'm on the other end of the pt care spectrum (premies), I am also convinced that this regulation thing is OUT OF HAND!!
Last month, I had to write competencies for our volunteer
cuddlers--they come in for 2-4 hrs/week and hold/console babies who need it.
Then another nurse and myself had to have them come in for ~ 90 minutes to have a class and get "checked off" on these competencies!
The concepts of ensuring quality and consistency are great, but the gestapo pervasivness (sp) are hard to take.
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