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Discussion

Ending the PPS MDS?

I am a brand new medicare and medicare MDS nurse, I will be doing all the assessments (among) a thousand other things for the MED A residents. We have another nurse who does the MDS for the other residents. We are a brand new medicare certified facility, my question is we have a resident who had been here and already had their OBRA adm mds done, about 3 weeks ago but had gone to the hospital for about a week and now is back and he is going to go on MED A, I know I just need to do a 5 day for now, there is no sig change and I don't anticipate him being skilled for too long, right now it is for behavior observation and medication changes(was in med surg then to psych) so I figure once he is stable he won't have the need for skilled. When I make that determination does the Dr. have to say he is no longer skilled or do I? AND since he isn't getting any therapies do I just no longer do the PSS/MDS and just continue with his OBRA schedule that the other nurse will do? Thanks

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The "book" way... The Dr. makes the determination when a resident no longer requires skilled care. (But, more often than not.. Dr. doesn't even really know the Medicare A guidelines and certainly isn't keeping track of who qualifies and who doesn't)

The "real world way".. I would call up Dr. X (or wait til he comes in if I know he comes routinely) & state "Mr Jones has completed therapy and no longer meets skilled care requirements. His last day of medicare coverage should be xx/xx/2008." Dr. says, "Ok". I write physician order "D/C from medicare A skilled care. Resident no longer meets skilled guidelines"

Unless he has had significant changes in his Cognition or 2 steps doen in ADL's, a new GT or a drastic decline and no therapy? Not sure how he still qualifies for skilled?

not sure if it's different in other states, but most of the time our docs have no clue whether or not someone is med a until we have them sign the certs, and they don't have any say in ending skilled coverage. we don't get an order to end skilled coverage, we just get the 2 day notice signed by resident/family and notify them appropriately that they no longer qualify for a skilled stay due to not have a skilled service. our docs might think the resident needs skilled care, but they don't know the guidelines and really don't want to get involved. i've never had a surveyor or umr wonder why we didn't have a physician order to end skilled coverage.

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