MDS Questions???????????

CapeCodMermaid, RN · Mar 25, 2004

Does it cause trouble if grace days are used ALL the time? 98 percent of the time our rehab staff uses some if not all of the grace days for the 5 day assessment.

Talino · Mar 26, 2004

grace days should be used sparingly, e.g., when resident missed a day from therapy, a holiday, a loa, an off-site md visit or rx, etc. when used routinely, you will be raising a flag. have you heard of dave?

confer with your rehab. staff on their intentions for using grace days.

1. do they want to place the resident on a very high or ultra high rug category?

to achieve this, section p1b: therapies should equal 500-720 minutes of therapy within the ard of the 5-day medicare pps assessment. to be in compliance, a minimum of 100 mins. of therapy/day should be started on day of admission up to day 5. habitual use of grace days for this matter on a 5-day pps is an absolute red flag.

2. or, they simply want to put resident in a rehab. rugs score?

to get a rehab high category, all you need is a minimum of 65 mins. in p1b. therapies (can even be a combination of therapies) and, the 15 day estimate should equal a minimum of 520 mins., and at least 8 days of therapy.

catlady, BSN, RN · Mar 28, 2004

Grace days are used on a "prn" basis, not as a routine. In which case you need to notify disciplines on a prn basis as well. The poster was looking for ideas on how to get disciplines to be more punctual and compliant in completing MDSs.
MDS Coordinators have resorted to a multitude of strategies to get disciplines to be more compliant. Fortunately for us, the quarterly QA "reality check" works since a Dept. Head can just be put on the spot by the Admin. Aggravation does not befit the MDS Coordinator, let it be the negligent department's enigma.
If it's an ongoing problem, maybe the strategy needs to be redressed?

I'm the clinical reimbursement coordinator. My job is to make money for the facility and reduce expenses. The most obvious way is through PPS. We also have an MDS coordinator.

Certainly I don't often use grace days on a 14-day assessment, but it happens. For the five-day, usually therapy will request grace days because they rarely see the patients on day one, and they don't have a full treatment staff on weekends. If they are only going to make medium or high, I will tell them to move the ARD back to day five or earlier, because they can get it with an estimate. If I can get an SE3 based on hospital data and rehab can't do better, I will set the ARD at day one to avoid a rehab estimate. Therapy almost always picks day 8; I have educated the program manager that if she achieves actual minutes prior to day 8, she should choose the date where she makes the desired RUGs category. More than a few times I am given an ARD of day 8 and find out on day 9 that the resident didn't quite get enough minutes for Very High, so I have to move the ARD back to day 5, or day 1.

On the later assessments, if they are not rehab, I will initially set the ARD to the first day of the window. But that may not turn out to be the optimum date for maximizing their score. Perhaps they need a few more doctor's orders, or a week into the window they have an IV started. I keep the MDS open until the last grace day or until I am sure I have maximized the RUGs score. (I just raised an 0/4 from below-the-line to above-the-line by rescheduling the ARD from day 80 to day 92, when we got a second doctor's visit.) The other disciplines aren't going to be up on what I am doing; they just need the date.

There is no way the other disciplines are going to know what dates I've picked. Nobody tracks the PPS schedule but myself and the program manager. It's only fair that I give them a calendar. There are often changes, which I highlight in bold type so they know it's a change. I don't use an actual calendar, but rather a list of names, type of assessment, the ARD, and the due date which I have set. I revise it and distribute it as needed.

For the non-PPS assessments, we distribute a more traditional calendar. The MDS coordinator will announce in the morning meeting whose MDSs must be completed that day. But there is always chasing to be done.

mystichi · Apr 3, 2004

If you are looking for continuing ed, try ceanswers.com

They helped me!

ADON132 · Apr 8, 2004

I am a MDS Consultant. I go to different SNF and teach the MDS process to employees that do not have any training at all. I also fill in as Interim MDS nurse at several dfferent facilities when their's has quit or gone on vacation or just when and where I am needed. I would be interested in talking to you about some MDS Training in your facility.You can e-mail me privately at [email protected].

CapeCodMermaid, RN · Apr 9, 2004

Here's a rude question. How much do all y'all make as an MDS coordinator?

robin_mds_nurse · Apr 17, 2004

Hi, this is my first post here. I registered several months ago, but never found the time to post. I have been the MDS coordinator for 2 years at 128 bed facility. 6 weeks ago, our PPS coordinator had a heart attack and died. This has left me to fill her position as well as mine. I have been working over 60 hours a week. The DON has been interveiwing to fill my spot and I am moving up to the PPS position. I am thankful to have found you all. I see a wealth of knowledge here. Luckily, we have wonderful consultants from our Regional office. I am glad to see information about PPS on here. I know the regular RAI process well, but PPS is definitely a learning experience!

~Thanks, Robin

snikodym · Apr 23, 2004

Do your nurses belong to AANAC? They are good for courses. Also the CMS elearning site is pretty good.

I was looking for some useful information on continuing education for MDS Nurses. I am looking to promote some RNs into an MDS Coordinator role within long term care facilities and hopw to get some information on classes or inservices that are held in the Indiana are to give them more knowledge regarding the MDS process?....Can anyone help!!!
Thanks
Laurel

MDSlady · Aug 13, 2005

Just when I was about to post my own question about the MDS....do any of y'all have suggestions for how to keep track of the dumb thing? I am new to the job...have between 25 and 30 Medicare residents at any given time. Most of them are rehab so the RC picks the ARD. I get MY part done the same day, but it seems I am forever chasing the rest of the team, and then I forget to pick the old ones up and almost miss the 14 day cut off for the Triggers and Raps. Anyone have a good form or method ??? HELP!

Hi..This is new for me, but I felt that I had to respond. I do MDS's for a facility of 150 beds. To keep track of my PPS people, I have a large blotter that you would keep on your desk with the months on it. As soon as I know that a new admission is coming in I immediately track what days I am going to open the MDS. It is good because I am the only one that has the "power" to open an MDS since we have electronic charting at our facility. So for instance, I count 9 days, and write that person's name down. So I know on that day, I have to open a 5d, and then count 14 days from admission and write the name down and that's my 14 day, Day 35 for my 30d and so on. Therapy will always let me know when they are taking someone off therapy so I can plot my changes in also. I find the blotter the best way for me. As far as my Medicaid people, I use the old fashioned system of index cards. If you want to know how to do that write a note and I'll try to help you out the best I can. :)

MDSlady · Aug 13, 2005

Does it cause trouble if grace days are used ALL the time? 98 percent of the time our rehab staff uses some if not all of the grace days for the 5 day assessment.

Hi again,,,,We use grace days on almost all assessments except our 14 day. I never use them then. I always use them on a 5d because I want to capture all that I can including what happened to them in the hospital

dd_txrn, ASN, BSN · Aug 19, 2005

Our therapy team leader sets the ARDs for our therapy residents. She uses grace days on EVERY 5 day assessment. She doesn't take into consideration the 'estimated # of minutes thru day 15'. In fact, she doesn't use those in her projected RUG level. I never get to use the hospital look back days because we go past day 5. I have a hard time talking to her because she is a little quick tempered and becomes very defensive and my administrator thinks she can do no wrong.. :nono:

I would appreciate any suggestions on how to handle this!!!!

Thanks in advance

Dana

Nascar nurse, ASN, RN · Aug 20, 2005

Ok, here is probably the stupid question of the month, but... I don't get how you all can just switch these days so easily mid flow. I must have been sleeping thru that part of training (oh I forgot - I never got any real training - just an RAI manual). Anyways, I am in a case mix state. In this state, we have an annual "medicaide" inspection and this include a large percentage of all MDS's to validate the RUG scores. This includes ALL paytypes, even PPS RUG scores. We do not have any type of computerized charting in our facility for the floor nurses. We set a date, inform everyone (nurses, therapy, dietary, ss, activities) and that is what we go with and hope therapy gets what they were planning. If I move dates around, then I lose the ADL tracker grid and nursing summaries that the nurses complete during the observation period. If I lose this information, then the surveyors come in for their audit and I can not validate my scores. (My state mandates that we have 7 days of ADL late loss ADL tracking for all 3 shifts). I can't see how I can have nurses completing this ADL tracker grid for all open days - they have more than enough to do now, plus without summaries I lose all documentation on speech, hearing, etc. Once in a great while I will ask them to extend their time frame (extra work for them) when I know I really need something such as an unexpected IV, but for the most part - we pick are date and stick with it. 95% of the time, therapy keeps right with us and gets the minutes they need. What am I missing here? Is this just because my state works different w/ all the validation obligations?