Role of Administrator and MDS

CapeCodMermaid, RN · Nov 23, 2006

Welcome to the world of nursing in LTC. The administrator is the person who is in charge of the facility...the finances, making sure all the many regulations about everything are being followed,dealing with family issues...in short...anything NOT clinical. The clinical piece should belong solely to the DNS,

The MDS nurse either does or in charge of making sure the MDSs get done correctly. The MDS is a report which must be done on every resident of a long term care facility regardless of their payor source. The state gathers information about the residents so they know who to focus on at survey time, and the Medicare residents are paid for based on the information on the MDS...for example, your facility is paid more by Medicare for someone who has OT,PT,and Speech 6 times a week who also has IV vancomycin than it does for someone who has PT 3 times a week.

Daytonite, BSN, RN · Nov 23, 2006

let me add something to what capecodmermaid has said. mds stands for minimum data set. it is a long form, which is now computerized (although a paper copy of them is still in existence), that is a "comprehensive functional assessment of long-term care patients" (pg. 79 of health information: management of a strategic resource, 2nd edition by m. abdelhak). it's government red tape if you want to think of it that way. it's the price we pay for having medicare and medicaid paying for medical expenses. it's their way of collecting data in order to analyze and contain medical expenditures in the medicare and medicaid programs. [remember the steps of any scientific process are to collect data, analyze it, develop a plan, implement the plan and then evaluate it--nursing process is exactly the same] it is, basically, data that cms (center for medicare and medicaid services--better known as medicare) has deemed is to be collected from all facilities who receive medicare or medicaid reimbursement for health care they provide to nursing home clients. once a facility accepts medicare payments, then they, by law, must submit mds data on all their residents whether those residents are private paying clients, medicaid clients or medicare clients.

a nurse who takes a position as an mds coordinator in a ltc facility has an extremely responsible job. an initial mds must be filed on each nursing home resident within 15 days of their admission to the facility. subsequent mdss must be filed on each resident every 90 days. remember i said these are "comprehensive" assessments, so they are quite involved. while the mds nurse ends up filling out the major parts of the form, other ancillary service providers (i.e. dieticians, activities coordinators, etc.) also have to provide their input as well. so, all this data collection must be coordinated. in many places the mds coordinator is also responsible for maintaining the permanent nursing care plan for each patient as well since the information required for the mds is the same information that needs to be known to develop the care plan.

most employees of ltc facilities don't get to see these mds reports. if you are ever in a ltc facility for a clinical rotation please ask to see one of these mds reports on your patient. i guarantee that you will be extremely amazed at the information in them. they assess the adls of each resident extremely accurately. if you can't develop a care plan for your patient after looking at their mds, then you're not understanding the nursing process and what a care plan is.

and, just so you or anyone else doesn't get the idea that nursing homes are being picked on, these data sets of information required to be sent to medicare are also required to be done in acute care hospitals by uhdds (uniform hospital discharge data set), in ambulatory care settings by uacds (uniform ambulatory core data set), and home health by oasis (outcome and assessment information set). you may also have heard of drgs (diagnosis related groups) which is a prospective payment system for hospital inpatients who are on medicare. information from drgs is reported on the uhdds. the feds compile all this information and you can get results of the statistical information from all this data at this site as it is also combined with icd-9-cm diagnosis codes also reported on these data sets: http://www.cdc.gov/nchs/fastats/default.htm

one of the ways the fed picked up that medication errors were a huge problem was through the collection of information on these various types of data sets. that has been one of the good things to come out of all this data reporting. you can also think of it this way: as long as the feds are paying for healthcare, they are wanting to know where every single dollar is going and how it is being spent. it is through reports like the mds that they are able to do that.

hope i didn't bore you or lose you half-way through that explanation. this stuff turns me on!

banditrn · Nov 24, 2006

Capecod and Daytonite - again, you two have come thru!:) When I started LTC, I had an idea what an administrator did, but I had no idea what the MDS coordinator's job was.

I really wanted to know, because I knew that she was involved in the admission process, and other things - but I just didn't know WHAT was involved. It's hard to just go up to someone and say "Hey, what's your function?" But that's finally what I did - altho with a little more finesse.

She was able to assist me a few times, when I wanted some thing or other for a resident. She was able to find a way to get it accepted and paid for.

brendamyheart · Nov 24, 2006

let me add something to what capecodmermaid has said. mds stands for minimum data set. it is a long form, which is now computerized (although a paper copy of them is still in existence), that is a "comprehensive functional assessment of long-term care patients" (pg. 79 of health information: management of a strategic resource, 2nd edition by m. abdelhak). it's government red tape if you want to think of it that way. it's the price we pay for having medicare and medicaid paying for medical expenses. it's their way of collecting data in order to analyze and contain medical expenditures in the medicare and medicaid programs. [remember the steps of any scientific process are to collect data, analyze it, develop a plan, implement the plan and then evaluate it--nursing process is exactly the same] it is, basically, data that cms (center for medicare and medicaid services--better known as medicare) has deemed is to be collected from all facilities who receive medicare or medicaid reimbursement for health care they provide to nursing home clients. once a facility accepts medicare payments, then they, by law, must submit mds data on all their residents whether those residents are private paying clients, medicaid clients or medicare clients.
a nurse who takes a position as an mds coordinator in a ltc facility has an extremely responsible job. an initial mds must be filed on each nursing home resident within 15 days of their admission to the facility. subsequent mdss must be filed on each resident every 90 days. remember i said these are "comprehensive" assessments, so they are quite involved. while the mds nurse ends up filling out the major parts of the form, other ancillary service providers (i.e. dieticians, activities coordinators, etc.) also have to provide their input as well. so, all this data collection must be coordinated. in many places the mds coordinator is also responsible for maintaining the permanent nursing care plan for each patient as well since the information required for the mds is the same information that needs to be known to develop the care plan.
most employees of ltc facilities don't get to see these mds reports. if you are ever in a ltc facility for a clinical rotation please ask to see one of these mds reports on your patient. i guarantee that you will be extremely amazed at the information in them. they assess the adls of each resident extremely accurately. if you can't develop a care plan for your patient after looking at their mds, then you're not understanding the nursing process and what a care plan is.
and, just so you or anyone else doesn't get the idea that nursing homes are being picked on, these data sets of information required to be sent to medicare are also required to be done in acute care hospitals by uhdds (uniform hospital discharge data set), in ambulatory care settings by uacds (uniform ambulatory core data set), and home health by oasis (outcome and assessment information set). you may also have heard of drgs (diagnosis related groups) which is a prospective payment system for hospital inpatients who are on medicare. information from drgs is reported on the uhdds. the feds compile all this information and you can get results of the statistical information from all this data at this site as it is also combined with icd-9-cm diagnosis codes also reported on these data sets: http://www.cdc.gov/nchs/fastats/default.htm
one of the ways the fed picked up that medication errors were a huge problem was through the collection of information on these various types of data sets. that has been one of the good things to come out of all this data reporting. you can also think of it this way: as long as the feds are paying for healthcare, they are wanting to know where every single dollar is going and how it is being spent. it is through reports like the mds that they are able to do that.
hope i didn't bore you or lose you half-way through that explanation. this stuff turns me on!

could of said it better!!

AbsoluteRN · Nov 25, 2006

Hello all! This question may scream dumb-dumb, however, I've gotta know; is the MDS Coordinator responsible for the actual assessments? Clearly, other departments give input, but if you were responsible for MDS assessments on 90 patients, when would you have time to complile the data?

Daytonite, BSN, RN · Nov 25, 2006

A good question. Like most of us who have worked in LTC, assessment for them is ongoing. I saw them checking report books all the time to keep up on things. And, remember that patient's are coming and going. MDSs are due every 90 days, so if you have 100 patients you report on, that is about 2 reports every work day, assuming that the census never changes. You learn to organize. Each MDS Coordinator handles this their own way. You will often see MDS Coordinators being promoted into this position, not being hired from outside unless the facility has no choice. It takes time to learn all the residents of a facility.

When the MDS Coordinators work on these reports (they are actually transmitted by computer), they usually shut the door to their office so they aren't disturbed. Gives everyone the impression that they are no where to be found!

Most go through the nurses notes and nursing assessments because, ultimately, all evidence has to come from nursing documentation. One facility I worked in actually had us charge nurses attend inservices that focused on what we should be charting in order to address all the information they needed for the MDS reports. I've seen the MDS nurses have informal chats with the charge nurses and CNAs. I've seen many who actually go out and either observe or sometimes participate in the hands-on care of patients depending on the time they have. The MDS nurses in some places are often one of the nurses doing the initial assessments on new admits. One MDS Coordinator used to have us charge nurses fill out copies of the MDS forms for her and then compare what everyone was giving her about each patient.

I also learned that the MDS Coordinator is the person to go to if I ever had a question as to who was currently on Medicare coverage. They are the ones who know what qualifies a patient for Medicare coverage and what we should be addressing in our charting. I was constantly wanting to know as soon as a patient was taken off Medicare status so we could discontinue that qshift charting and daily head to toe assessment that was required. We also needed to get the patient's medications sent back to the pharmacy for the credit that would come back to the facility and get the medication re-ordered and charged to their new payer. SO-O-O-O many things to keep track of in LTC!

wooosp · Nov 25, 2006

wow....so much info, but thank you very much for the input.

very helpful!:thankya:

brendamyheart · Nov 26, 2006

Could of said it better!!

Opps, ment to say could not have said it better