Pushing The Limit For $

I really feel comfortable that when I sign on R2B I sign that the MDs is complete, not that it is correect, I will not sign for the sections that I feel are inerror, as I said, I am siging R2B, and the way I read it , that is only indicating the MDs is complete, this particular orgainization has been purchsed by a new owner and the $ stretching is not going away...here in NYS, the reimbursement has also changed for MEdicaid from a PRI to the MDs, and now at this particular place, we have lived thru inservices oto the CNA's on how to "document", of course the push is to document the maximum assistnace the cna gave at all times, once again, not illegal, just shy of it in my words, but all of the administrative people, feel this is totally appropriate and within all of CMS guidelines, we were just never getting paid the "right" way for all of our hard work before, so if a CNA provided hands on 1 time in an ADL activity, they are being told to put down assist of 1 for any minute weight bearing act, and even for those folks who eat, in the main dinning room, there is a nurse in there for all meals, just in case they are needed, and the folks are served resturant style, everyone is being ut down at least for supervision in eating, even if they are independent walkie talkies and can go into a returant and order a meal, becuase they are being "supervised" ...once again, I am arguing they are supervised because that is how we wet up the dining experinece, not becuase it is needed, HELP ME !!! So frustrated I can not spell right

That is my take on the subjecct, and thank god ,

Yes, I have also joined that "crowd" the facility is so going for the big $" that I am doing extra Quartely's on every applicable state resident to up the score for Case Mix, ... and to top it off isn't it a miracle that these peopla are all of a sudden getting Restorative Therapy and it just happens to be during a lookback period, it's a MIRACLE.... I can not imagine that the Dept of Health?CMA?State who ever, is going to allow this... I really feel this is not right... and my stance, if it ever comes up , will be I was told to scedule and assessments, I did, I completed it correctly based on the manual, I am glad I am not the OT or PT providing the therapy, because I would really have a hard time justifying this practice, even if "everyone else is doing it", I am not putting anything false or incorrect in the MDS to bump up the score. I am actually at 2 different compainies, one is so very reasonable and doing the right thing, the other is just all for the $, and this is horrible. AT this "other organization" I am no longer doing MDS to improve the lives of my patients, I am now completing MDS for a "for profit organization" to gleam every last penny, even if it takes me hours to get that PC1 to be a PC2 and have the RUG score jump up by .02... and it makes me sick.....and heartbroken, I did not become an RN to do this....

I am all in agreement with the extra $ spent for the staff to do the work, but since we are salaried, we are expected just to get the job done, so , the facility believes they will win more $ in the long run pushing the slave/salaried mds workers get the job done and hunt and peck out those RUG's, can you tell, yes I am annoyed at this practice !!! And no, they do not cange the meeting schedule nor the annaul, they are just extra quarterly's, and no , there is no policy and procedure for this.....

You are so right and this whole thing is heart breaking. Now into the second attempt at the case mix upload for NYS reimbursement, I find that my MDS role seems to no longer be to get the best patient outcome but to get the best fiscial outcome. I am no longer a nurse during these "capture periods", but a number cruncher, and I am heartbroken and frustrated as I have loved doing MDs in the past and explaining how the whole process works from getting someone in the door to MDS creation to care planning for the best patient care possible, now my whole role is focused on eeking out that last little bit of 0.02 to a RUG score. The interesting thing is that in one facility I am part time and they are the ones really pushing , pushing, and in my full time job, this is not happening. Amazing how one corportion is really smart and one is really pushing the limits