disney158

I used to work in Pittsfield MA, so I also suffered thru thse audits, not a very fun job we have, so many people to please....so many people to teach to do the right thing....uggh...I just came to work depresseed already !

I'm glad I stumbled into this thread, in Jan. 2009 NY went to case mix for reimbursement based on MDS and I can't tell you how angry I am and annoyed, at one organization I work at. What a miracle that 75% of the Medicaid patients in this facility needed some sort of restorative therapy during the capture period, and I'm talking about everthing above a RHB even up to RUB, and that remaining 25% miraculosly fell into a skilled or special care category. How lucky for that organization!!!!!:imbar:eek::angryfire Tell you what, I am mortified that I am involved in this as the MDS person, and I can not believe the OT's PT's went alng with this and did these "therapy " sessions and the Dr.'s signed the orders. Of course, the bull ****... it's good for the patient" was thrown about, give me a break, lets do RPT 5 x45 minutes for 3 weeks so it will be easier for the CNA's to transfer this mechanical lift, non-verbal severly Demented... really now, this person had no need for this therapy is no different than she was before the therapy and is no different no. EXCEPT the organization was able to get more $ by increasing the CMI... this is total and utter "rape the system" for the money, but in the end is is our $ that will be affected, all of these budget cuts are happening as I am sure many for profits are playing this game , and it is total crap.

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:banghead:

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.....

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....

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

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

"they are recieving PT and OT, and they are only cut form OT, you must give a cut letter for the OT when it is cut. This is a new rule, and there is a special form for this." VeryBerryRn, can you site where this came from, and the special form I am stupid and can not find it on the Web, thaks so much !! Nadine

Update : Did I also say that I also put in for the grant for my part time job at another SNF , and also GOT THE GRANT THERE TOO ! So, I have obtained almost $80,00 for 2 SNF"S which is more than my salary ! That facility has sent me a huge flower arrangement and is writting press releases thaking me, at the FT facility I first posted about a big fat NOTHING !!! We even have a new DON and the adminsitrator mentioned the grant we recieved at a morning meeting, the DON asked who worked on the grant and the administrator said, " I did", so now there have been 3 emails and multiple verbal accounts by the administrator staing "he worked" on the grant, with absoultely no acknowledgment for me. That was it and I went to Human resources for support, confidentially and it was suggested I speak with the administrator. The administrator is stopping by my office today to discuss this, and I am tyring hard, really hard to keep my composure... I have already cried multi[ple times, and have all of the documentation in a binder of all the work I did and all the work back and foth between my self and vendors. It will be impossible for the administrator to indicate he did the grant alone, also in my orgininal and subsequent versions of the grant paperowrk, I was to be the administrator of the grant, I guess that must have changed too... oh well, I feel sick... will continue to up date as I greatly appreicate the support, I hav never been here before... Nadine

Thanks to all, this happened yesterday and I am waiting as I am too angry/hurt/annoyed to approach this topic with him. He is the administrator, young ( middle 30's been in the field for about 10 years, 2nd administrator role), very upwardly mobile with high asperations... I can't tell you how many weeks, hours, went into that thing, specific language , no more than 1 page to define what was asked for, specific page limits for specific parts, it went on and on , then the pieces of the grant would be assigned points to see how correctly you responded , the points were addedd up and those with the most points recieved the grant. I worked on it at home, called venders, suppliers, searched for the best pricing, agonized over the verbiage, and then handed it over for "tweaking". Let me tell you, I feel 'tweaked" :angryfire This was also done while I was doing all the MDS "stuff" for a 82 bed SNF with 25 Subacute beds that are always filled, and chairing all the care plan meetings, the chair of the Falls Comittee, on and on ...I am so sad , but do not want to dig my own grave by angering my adminsistrator, he has all the power...but I can not go on like this, I feel like a volcano with the lava brewing.... all of your suggestions were great, I will wait a week until I go back to basline and then approach with ...can I help in the delivery of the grant and can I have something to put into my personnel file that reflected the work I did on the grant..., and I will add it to my resume... but still.... in this tight fiscal hospital/snf enviornment, recognition from upper level management would have been , in my eyes, appropriate... so is almost $50,000 nothing to speak about ?

I don't mean to sound ******, but, I told my supervisor about the opportunity of a grant for the facility, I worked on the grant paperwork endlessley for a month, took it home, aganoized over it , etc. Since it was the first grant I have ever tried for, my supervisor, the administrator, helped, "teaked" it, improved portions of it, and then sent it to the facilities "grant writting team" for further enhancements. I worked on it for weeks, hours, besides completing my regular work. He just heard yesteday that we recievd the $40,000 grant, we are a 80 bed SNF in a 300 bed community hospital. My issue, I was the one who found and researched the grant, brought the ideas to my supervisor, created the pages and pages of documentation, called for pricing, etc on and on. I found out thAt we recieved the grant when a general memo was sent out yesterday by my supervisor, thanking all who worked on the grant. I was not individually mentioned, even though, only he and I , besides the tweaking by the grant team, where the only ones who worked on it.. I am so beside myself and angered...:angryfire I took that grant home, slaved over it and am getting no recognition... My husband tells me I have become Melanie Griffith in "Working Girl" and the administrator is Sojurney Weaver ( workng spelling, but you get my meaning). Help me handle this please....how do I professionally indicate my frustration, or do I ?

Prioritize, delegate,...."any problems can be blamed on your predecessor?" ... I am perfectly okay with this statement, most times it is true... but fix those problems, first.. make a difference for positive change and you will be respected and worked with. it is not whiney or finding an excuse, as long a it is the truth. What a terrifying idea to be placed in the dual role you have, we know MDs is time driven, and now you have the gift of an addittional job that will swallow up all of your time like a black hole. My two cents, MDS goes to Unit Mangers or RN's with a weekly "come to Jesus meeting" with you, face to face, to be sure they are finished correctly and timely, you can do a quick check of sections that count the most, those for QI/QA and reimbursement, and that part is taken care of. The best DON's I know are those that empower their staff, appear to be incontrol and calm, and are approacheable by staff. They also delegate, and review what has been delegated, give specific time frames with specific expectations and then reward when complete, even a simple email , "thank you for a job well done and timely, I apprciate your work" goes a really a long way. Don't micro manage and think you must do everything.. good luck.....

"before cell phones, IMO, there werent as many "emergencies" and if there were emergencies...they were made and recvd from the company phone" :yeah:I am so glad so many people think like I do ! I started the thread, and still am constantly embarrassed by having to speak with family members about the staff with the blue tooth device... you can't imaginine how indignent the CNA's get with me... ie: " my babies come first before the job".. can I say to this person,.... "well then you don't have the right job and I am willing to take the job back from you...try Walmarts or McDonalds" ... it has been getting to the point that when I see a staff member..peer RN, CNA, LPN, Tech, buzzing, beeping or ringing during a meeting, inservice or speaking with family's/patients ... my whole outlook and facial expression changes, my faces turns red..I can't help it , it is now an autonomic reflex, and god help the person if they check the phone... I can just not imagine being so rude to think the employee is "entitled" to this behavior, the patient is not even a thought in their head...

You do have manners and I carry a cell too, but can you believe someone would do this to a resident. And to top it all off , to get natsy to me when I told her not to use the Bluetooth ever on the floor, can you imagine what they can do to already confused residents, arent' the residnets to be the focus of care, that wouldn't even be tolerated at Walmarts.... which is where I wanted to suggest she go work, but I held back..

I just remembered, is it Bluetooth ?

What is it with some staff??!?!? Ho many times do they need to be told , "No cell phones on the floor"- I am so annoyed, actually had a CNA working ADL's with an alert resident talking to someone on her ear thing (can't rememer what they are called right now I am so annoyed !) and the rsidnet was so confused as she could not tell who the staff member was talking to , the rsidnet or the person on the ear bud thing... I literally had to go to my office and chill out prior to talking further with the staff person after I called her out of the room to get off the phone .. hoow rude can you be... I am so tired ot staf acting "entitled", ie : "My kids gotta get me some how if they need me you can't tell me not to have my cell with me , they need to get me in an emergencey ..." Funny, but before cell phones existed , there were emergenices weren't there ? Can you just imagine being the poor little residnet in the bed trying to figure out who the hell the CNA is talking to ? Uggh.....

Nope, no-one... corporation is now purchased by a new owner, so we will see what happens, as we know, new owners sometimes "clean house" so i won't have to worry, maybe the administrator won't be there too long.. I can always hope....

I too am in NY and we too have all been to the same workshop, as if it isn't bad enough to do the calendar right, now we will be playing the "move the ard" game for NYS reimbursement also, I have some clincians who still can't get the right dates no matter how often I go over it, I am told I am talking "MDS", did you know that "MDS" is no a recognized language of it's own, ... and these are smart people..

"he is as unscrupulus " His vision of this theory is that it is perfectly okay, even spoken about in all of the Medicare pushing the RUG dollars we have all gone to... indicating the system was set up by Medicare so why not use those rules to our advantage ... , back to my basic quetion, what touble can the team and I get into ? Now I feel ill....

not yelling back either, but, i see the residents regulary during meals, activities, etc i did not count that time, as it is part of my overall day, seriously, with the computerization, i am not kidding, add in the time on the floor and it will go up a bit, but actual sitting down time at the computer really is 1/2 hr or less, for that facility, as i said, not having to compute adl's or paw thru sheets and sheets of mars, really helps, face it, like it or not, the use of the computer to make work less and faster, is a benefit as it allows more time to be with the people. you should see the cna's at the kiosk entering the data, they actually talk to each other about the residents and getting in the correct information, which i can get for sections e, g, and h in a few clicks, and shave off at least 20 minutes from completing the mds, and that is a benefit, and not incorrect... and, in my mind, and other's, endlessly obsessing over the rap is a waste of time, if it triggered, why in the world should it take so long to figure out what to do, if you look at a person wholeistically, rather than divided in to 18 sub-divisons, and answer the rap process this way, many of the 18 raps share the same triggers and can share the same care plans,- but we haven't even talked about care plans here.. no one can tell me that for a severly demented resident who has lived in my faciilty for 10 years, who needs help with adl's, no medical concerns other than your standard 6 -7 dx,which will trigger 8 - 10 raps, i should take 2 1/2 hours ( at your minimun of 15 minutes) to "do " those raps... ... thinking this way , if you care plan lets say, 8 residents a week 4 full mds and 4 quarterlies, most of your week is spent with the mds, just those mds.. i think it really is an issue that comes down to if a individual clinican feels/documents they have addressed all issues, the resident is well care planned for, and survey is confident you have a true picture of the residnet, why not rejoice that it can be taken care of faster, rather then try to "tirade"---have you worked with care tracker or a computerized medication administration system, or are you still laboring over counting each little swiggle in a med book or a cna flow sheet..or trying to read individual staff hand writting... ..please don't indicate that i am not doing a good job b/c i am quicker than you

So frustrated !! One of the places I work has a administrator who is really pushing the lmits of Medicare.. this goes beyone Ruging for Dollars, way into me thinking... "if this chart gets pulled for review Medicare will take back every last cent"... Nurses notes are lacking or the same old , v/s stable no signs of infection, etc... this administrator is having me cover individuals who RUG out at PA1... ( he/she was in a psych hosp with a 3 day stay ), PD2 (he/she went out for mental status changes, pulled out the IV, had po abt and RUG out at PD20, therapy ended 2 weeks ago and we are mointoring them to be sure they don't decline... on and on and on...I feel as if this is fraud, not even pushing the limits, myself and other nurses, therapists are feeling the same way, we rool and eyes and whisper under our breath, oh my god, how are we going to justify this ? :argue::argue:Everytime we review this with the administrator, he indicates this is all coverable and appropriate under Medicare Part A for skilled observation, and I am reeling, what are we skilling for ?!?!? I'm so glad that all I do is complete the MDs and not be held liable for the decision to keep the person on, I'm okay , right ? I am not making the medicare decision, of course this is documented no where, should I worry if Medicare comes looking ? I am doing the MDS correctly, if nothing happend in the hospital stay or look back period, than nothing happened... but , this is all making me very very ill...thoughts please , no , I cannot quit, and no, I can't go above the adminstrator, been there done that all I had was negative outcomes for me...

I am an RN in upstate NY, location and salary really do go hand in hand, and work at 2 SNF, full time one $29.5 hour, part itime job $32.00 hour (been there 10 years), at both I do all of the medicare assesments, calendars, schedules, Medicare Meeting, Medicare cuts and determinations, run all care plan meetings, liasion with therapy, but really that's it. I am so blessed, but we have big numbers, in the 82 bed SNF we are running about 25 Med A, currently going up to 40, not difficult to find patinets as we are hospital based and the hospital oves to "dump" on us when their census gets too high, But I do have to tell you, that I very quickly and accuartely get MDS done, as we have Caretracker, med administration is comupterized, so are all of our notes, the only data I can not get at the touch of my fingers are MDS Visits, orders and skin assesments. Everything else is in the computer !!! Including Incident reports and Therapy !!! This is an amazing TIME SAVER, I hate to say that here I can get a qtly finished in less than 1/2 hour, full in less than 1 1/2 hours from start to RAPS, because we are computerized and everything is at my fingertips.:yeah:Not true at the other facility where only the MDS is on the computer and it you can add an extra hour to the times trying to look for, and trying to read the data there. Handwriting, CNA flow sheets, uggh , what a nightmare.. as i said, I am truely blessed to be at my full time job :)

I have been a MDS coordinator for 12 years, it really depends on the administrator to see your value and not send you to the floor as a "staffing accessory", has never happened to me at my curent job, which is why I am still here after 6 years, and why I left the other job, some times better to be a floor nurse than a unappreciated MDS nurse !!!

We have had Care Tracker for over 2 years and it is a life saver, I am sure the company will keep up with any changes to the MDS including conversion to 3.0

Have to say it and can only say it this way, that person is NUTS !!! For multiple reasons, some of the MDS questions are "expert opinions" not a data item like a height or weight and the arguments can go on forever !, for the sheer sake of time alone, you will never get any other work accomplished, and speaking fiscailly, why the hell would I want a team of professionals wasting time completing a document not designed to be completed in this fashion, let the interdisciplinary process occur after the data collection process has finished, in other words, make the care plans interdisciplinary not the data collection, I can't imagine you facility administrator would even go with this idea !!!