Ending the PPS MDS?

[jpav33]

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

[Nascar nurse, ASN, RN]

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"

[mdsmadness]

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?

[Rexie68]

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.