Kasey Stevens | Quality Insights: right get started this afternoon. So good afternoon. And welcome to our series of webinars focused on bringing you information about COVID-19 related topics. Information in these weekly webinars is your towards the long term care and skilled nursing facilities, but we encourage everyone who is interested to attend. My name is Casey Stevens. And I'm a communication special with quality insights. Today we'll be discussing the minimum data set. Mds changes are coming.
Kasey Stevens | Quality Insights: Everyone has entered the webinar on mute
Kasey Stevens | Quality Insights: it. But we will have a discussion following the presentation. You have any questions or comments, please submit them, either using the chat feature or the Q. A. Tool in your zoom, and you can also raise your hand to request to be unmuted, or to ask your question. Allowed.
Kasey Stevens | Quality Insights: We invite you to join us every Wednesday at 2 Pm. For more of our weekly webinars next week we're going to be discussing the Mds changes and highlight sections B. C. D. And E.
Kasey Stevens | Quality Insights: And now I'd like to introduce our guest speaker today, Deborah, right?
Kasey Stevens | Quality Insights: Deborah is a quality improvement specialist here at quality insights. She joined our team, after being in the long term care industry. For more than 30 years she has a wealth of experience and long term, care and
Kasey Stevens | Quality Insights: long-term care, nursing and management raised, ranging from certified Nursing assistant to Vice President of Health care operations. She's most passionate when working with the Mds process in quality improvement.
Kasey Stevens | Quality Insights: Yeah, thanks for joining us today, and I'll let you take it from you.
Debra Wright: All right. Thanks, Kathy. So this is the first time I'm manning my own slides here. So if any time something doesn't look right, please stop us and let me know.
Debra Wright: So we hopefully by this point I'll know that the Mds. Is changing October first. So my goal. And why can't I move this sign?
Debra Wright: There we go. My goal is not to be
Debra Wright: instructing you on how to complete the Mds. Our goal over these next couple of weeks is just to draw your attention to what is changing within the Mds, and then, answer any questions that you have. So the first couple of slides will be the same every week, just in case we have different people joining us. So the first slide here has the links to the Mds forms and the Updated Rei manual.
Debra Wright: And there's also a link for the Cms official Youtube channel, where you can go to their Youtube and kind of do a search for the topic that you're looking for. And here's just an example of some of the different training videos that they have on different sections. So you can go to their Youtube channel and Google, section B of the Mds and get
the hearing speech and vision section and then watch videos on their training of those
Debra Wright: so globally there. There have been some changes to the Mds Rei Manual, not going to go through all of those in each and every section. Just know that throughout the manual content has been updated to include general neutral language. And sometimes even today, probably when we're looking at the examples, I'll stumble over it a couple of times because it's not how we're used to seeing their
Debra Wright: examples. But they just did this in a way that to be gender-neutral across the border.
Debra Wright: There's minor updates to wording to enhance better understanding. They've given additional examples. to improve the clarity of the coding section.
Debra Wright: as we all know by this point keys has been changed to I keys, and there's been a revisions made pertaining to the legal information for family members significant, others, the representatives just to provide consistency throughout all of the the conversations.
Debra Wright: So there's been changes and revisions in chapter guidance to Chapter 1, 2, and 4, not going to go through that just drawing your attention to it. And then throughout this month, we're going to be taking all of the sections that have either have new or revisions in chapter 3. So these are all the sections that have had some sense of change other than that general neutral or examples that have been given
Debra Wright: so section a identification information. So Heather, I see you have your hand raised.
Debra Wright: Okay?
Debra Wright: So the intent for Section A and almost all of this, if not all of it has been taken right from the Rei manual. So the
Debra Wright: font and red means that those have been changes, updates, things that are new. We. I kept it that way just so that you could see the changes. And a lot of this I'm just going to to read, and I don't mean to to be reading the slides, but it's right from the Rei, so it kind of it is what it is. So
Debra Wright: the intent of Section A is to obtain the reason for the assessment, the administrative information, and the key demographic information to uniquely identify each resident. Their potential care needs including access to transportation, which is new for this section and the home in which they reside.
Debra Wright: So here is what the The types of assessment looks like. It has been changed, and it only now is federally required and pps assessments. So the optional state assessment has been removed from this, and the optional State assessment for Pennsylvania will be discussed at a later time. Pennsylvania will be
Debra Wright: pretty much continuing with all of the Mds. Assessments that we know now, and we'll talk about that more. So when we get I think it's in 3 weeks when we start talking about Section Gg, and I say, sex and G has gone away.
Debra Wright: It really hasn't gone away, at least not for Pennsylvania. We have reached out to West Virginia to find out what they are going to do for the optional State assessment, and as of the end of last week they still did not know.
Debra Wright: So we do not know yet if West Virginia will be following a Pdpm for their for their Ma. Case mix reimbursement, or if they will be doing an optional state assessment. Once we hear that we will work with West Virginia Health Care Association and make sure that you have that information.
Debra Wright: Pennsylvania has made the decision. They are doing the optional State assessment, and, like, I said. We will be having a separate webinar just for Pennsylvania on August fifteenth, and there'll be more information coming out with that when you get the slides and the recording for today's session. There'll also be registration for that presentation.
Debra Wright: So what has changed in Section A so ethnicity has been expanded. So you gonna have your list of the the typical? No, not of Hispanic Latino, Spanish. They've added Mexican, Puerto Rican, Cuban. They've also added 2 additional
Debra Wright: sections. Sec, responses. Response X means. The Resident was unable to respond and Rex.
Debra Wright: response. Y means resident declines to respond. So there's going to be an opportunity where you are going to to check all that apply. So the most important thing is you're going to. I ask the Resident what did what corresponds to their ethnicity and whatever they say, that's what it is.
Debra Wright: But we also know that this and the race questions sometimes are sensitive questions. So they've really worked on. How is the best way that we can ask this question that makes the Resident feel comfortable?
Debra Wright: And right here is a quote right from the Rai that States. We want to make sure that all our residents get the best care possible, regardless of their ethnic background. We would like you to tell us your ethnic background so that we can review the treatment that all residents receive and make sure that everyone gets the highest quality of care so hopefully asking it in that way? If it's someone that you feel may be sensitive to to these questions.
Debra Wright: that may be a better way to ask that question.
Debra Wright: So what can you use to code this? The you can use the medical record if the Resident is unable to respond, and there's no family member present
Debra Wright: if the Resident declines to respond, though
Debra Wright: you have to code based on that, you can't code based on the family. So if the residents says, I don't want to answer that. And there's significant. Others says they're African American. You can't code African American. You have to code that the Resident declines to respond.
Debra Wright: If the resonant provides a response, then you check that box indicating what ethnic category or categories they identify as
Debra Wright: where you're going to use the X is, if the resident is unable to respond, so the resonant cannot respond. Whether the family or significant. Other representative answers for them, you still have to check that X as one of the options.
Debra Wright: If the residents unable to respond, and there's no other resources, then you would code X alone. and then you would code the why like, we said, if resonant, declines to respond.
Debra Wright: So here are 2 examples. Resident R is admitted following an acute cerebral, vascular accident with mental status changes, and is unable to respond to questions regarding their ethnicity.
Debra Wright: Their spouse informs the nurse that resident want resident R. Is Cuban. So how would we answer this question?
Debra Wright: So we would. Code d. Yes, that they're Cuban and X resident, unable to respond. And that's because the resident R. Was unable to respond, but their family provided the response. So we code the family's response and code that the Resident was unable to respond.
Debra Wright: Resident K. Is admitted following a total hip after classly and declines to respond when asked their ethnicity. So how would we code this?
Debra Wright: We would code why? Because the Resident declined to respond, and we would not use any other sources, because the the residents said they do not want to respond. And these examples are right. From the Rai. There are more in there. I just pulled out a couple to show today.
Debra Wright: So then, race. They also expanded this, and you can see from the list. There are multitude of other options that are now available to choose from. It's and why did? Why was this? We? They wanted to standardize the self reporting data collection across post acute care settings. So they're trying to. The reason for all these changes this time is they're trying to make the assessments that are used in all post to queue care settings
Debra Wright: the same and interact and interchangeable. So whether they're going to assistant living, they're in long term care or home care. They want the questions to be the same. So they've kind of combined them all together.
Debra Wright: The one thing that's important. They course. They give the example, again, of how you can introduce this question to an individual that may be sensitive to why are you asking what my races? And it's also important to know that these answers and these categories that that you're coding are not to determine eligibility for any participation in a federal program. It is simply, how can we best provide the care for the resident based on their ethnicity and their race?
Debra Wright: So again, these coding things are the same as the ethnicity you are going to ask them what race they associate with. If they're unable to respond, then we can ask the family or look at the medical record. If
Debra Wright: if a family member provides that information for us, then we would code their response as well as coding X. That the Resident was unable to respond. And again, if the Resident declines to respond, we would do. Why, whether the family answers or we can answer for them based on information, we would still code. Why, if the Resident declines to respond.
Debra Wright: and then, if we're not able to determine from any of the sources, then we would code see
Debra Wright: so examples, for these are resonant. W. Has severe dementia with agitation during the admission assessment they are unable to provide their race. Their child informs the nurse that resident W is Korean and African American. So how would we code this?
Debra Wright: So we would code 3 things. We would code that they were black African, American, we would code that they are Korean, and we would code that the Resident was unable to respond.
Debra Wright: Resident Q declines to provide their race during the emission assessment, stating I'd rather not answer. So we would code. This is why Resident declines to respond.
Debra Wright: So the language section has been revised. before, we would say, does the we did the Resident need an interpreter? Yes or no? Now they actually want us to put what is their preferred language, and we have to type it in there, and then it says, Do you need, or want an interpreter to communicate with the doctor or healthcare staff?
Debra Wright: So the purpose of this, you know, is just to make sure that the Resident clearly understands what's going on with their with their health care plan. So we want to make sure that we are communicating in their language.
Debra Wright: If the residents or family member does not identify a preferred language, then we have to dash that first box. However, we we do need to realize that Cms expect that to be extremely. We're extremely rare because we need to be able to communicate with the residents that we are serving.
Debra Wright: So we would code this with, no, if the resonant does not want an interpreter. Yes, if they want an interpreter and 9, if we are unable to determine
Debra Wright: if they need or wants an interpreter.
Debra Wright: Transportation. This is a whole new section and one that we're, you know, we're going to have to figure out who's going to ask this question. And how are we going to document the responses to this?
Debra Wright: So the question is, has lack of transportation kept you for medical appointments, meetings, work, or from getting things needed for daily living?
Debra Wright: And the answer. And you're going to check all that apply. and it would be, yes, it is kept me from medical appointments or getting my medications. Yes, it has kept me from non-medical appointments, meetings, work, or from getting things that I need.
Debra Wright: No, it hasn't interfered. Or, again, this X resident, unable to respond, and why resident declines to respond.
Debra Wright: So the steps for this assessment is, we're going to ask the Resident in the past 6 months to a year has lack of transportation kept you from those medical appointments, or getting your medications, or from the non medical appointments, or meetings, or things that you need?
Debra Wright: They should be offered to answer Yes, they should be. If the resin is unable to respond, we can talk to the family member or their significant other, and then, if only if the Resident is unable to respond. And there's no family member present. Can we use the medical record documentation? And again, if the Resident declines to respond that we would not code based on what the family or the medical records has in place.
Debra Wright: So again, this is just a repeat that we would code a for yes, it is. Cut me from my appointments and getting my medications. We would code be. Yes, it's kept me from non medical appointments. So again, it could be multiple. choices. They could say that it's kept them from their medical appointments.
Debra Wright: we would. Code code no, see if There was no lack of transport. The lack of transportation has not kept them from getting to those things. And then again, X, if they didn't respond, and why, if they declined to respond.
Debra Wright: So here's an example.
Debra Wright: Resident E is an emitted with multiple sclerosis. They are confused and unable to understand. When asked if they have had a lack of transportation that is kept them from medical appointments, meetings, work, or from getting things needed for daily living. There's no family significant, other, or legally authorized representative with related information available, but their medical record indicates that their spouse uses their car to transport resonant E wherever they need to go.
Debra Wright: So how would we code this.
Debra Wright: So we would cod it as C. No. And x. That the Resident was unable to respond.
Debra Wright: 2 sections that have expanded is Where has the Resident entered from, and where they discharging to? And, as you can see here, from the list of lot of different things, have been added, they've added the short term general hospital, the long term care hospital inpatient psychiatric, intermediate care, facility.
Debra Wright: hospice from home and hospice from an institutional. So we know that there's some facilities that have onsite hospice units. So that's where this hospice institutional facility would come from
Debra Wright: critical access hospital
Debra Wright: home under the care of an organized Home Health Service organization, and then we would have the deceased and not listed, and it would go on to the next section. Then
Debra Wright: another new section is provision of current
Debra Wright: reconciled medication list to subsequent provider at discharge. Now there's going to be another one that says just a discharge. So the first one is If.
Debra Wright: when you said that they were discharged, where did they go to? If they went to one of these locations, the skilled nursing facility, one of the hospitals, psychiatric hospitals and hospice. critical hair. hospital.
Debra Wright: They're going to want to know. Have we provided a current reconciled medication list to the subsequent provider that's now going to be assisting in that person's care.
Debra Wright: So you can see how this is involved. You know, the last time we had a big Mds change. They added that drug regimen review. Well, now, they want to know. Did we truly provide the medication list to the subsequent provider. We all do, but now we have to prove it. So you're going to have to make sure that you're looking at your facility processes for how you're going to prove that you provided that reconciled medication list to the subsequent provider
Debra Wright: can't make my screen go down. Okay.
Debra Wright: So we've already talked about the rationale. So the coding for this is no. If it discharged to a subsequent provider. Your facility did not provide the residents current medication list.
Debra Wright: and the Resident was discharged to that provider, or we're going to code. Yes, if it discharged to the subsequent provider, your facility provided the residents current medication list.
Debra Wright: And this is all stuff that we've we've already talked about. So the coding tips is, you know, it's important that we send that reconciled list so that they can continue their treatment.
Debra Wright: This can be done by a number of means. We can mail them electronically, verbally, we can do it through an electronic health record portal.
Debra Wright: it's all in what your facility has set up for, how you're going to get that information to the next level of care.
Debra Wright: So some examples Resident F was transferred to an acute care hospital within reconciled medication list that included a list of their current medications, but with less additional information than is usually provided by the sniffet discharge because of the urgency of the situation.
Debra Wright: Some of the contra indications, as well as the residents, wait in height and dates of those were admitted from the medication list. So how would we code that we sent the a reconciled medication list to the subsequent provider
Debra Wright: we would code. Yes. So despite the fact that we maybe didn't send everything we typically said, we did send the the list of reconciled medications
Debra Wright: resident J's Medicare part, a State ended and they were transferred to a long-term care unit in the same nursing home. The idt from the subacute unit staff provided and reviewed with the long-term care staff a reconciled medication list at the time of transfer.
Debra Wright: So we would code. Yes, so even if they're going in the same facility. But if they're going to a different set of caregivers, we still have to prove that we provided that reconciled Med List to the to the new care providers.
Debra Wright: and lastly, Resident G's reconciled medication list was electronically fax to the subsequent provider, and this action is documented in their clinical record. However, the subsequent providers. Records do not show that the document was received successfully. How would we code that
Debra Wright: we would still code it? Yes, because we sent it, and as long as we have documentation
Debra Wright: that they received it, it's not our responsibility to ensure that they have a successful receipt of that. Now, I would think if we're going to fact that we would, we would want to have that. But
Debra Wright: as long as we can prove that we faxed it, and we have documentation that it went through successfully. We have that.
Debra Wright: So then you're gonna have to document. How did you send that to the subsequent provider? Did you send it through Ehr through an information health exchange verbally, paper, such as facts, copies, print outs, or other methods such as emailing or Cds.
Debra Wright: And we are going to do the same thing with the Resident a discharge. So if the Resident is being discharged, we still want to show that we provided the resident and or their caregivers a list of their current medications.
Debra Wright: Again, the same amount of wrote
Debra Wright: round of transmission. How did we do that? Did we give it to them in person. Telephone More than likely. It's probably not going to be electronic health record. But there are some that they, if they have access to their patient portals. We can do that. So that's what we would do with that.
Debra Wright: So coding tips. it's gonna be important to make sure that the route of transmission is is usually established with each subsequent provider depending on how they are able to retrieve the information from your facility. So
Debra Wright: if someone is going out to the hospital and they're going to hospital A, you know that you're always going to print out your
Debra Wright: medication listing and send it with them, or maybe you are attached to a hospital, and you both have the epic system. And you're going to say that, you know, if they're going to that hospital system. They can access it through epic. You're going to want to have that policy and procedure in place as a backup to help prove. How are you submitting these med reconciliations to subsequent
Debra Wright: providers, or when someone is discharged?
Debra Wright: you, there can always be more than one mode of transmission as well. So again, you're gonna check all that apply.
Debra Wright: But those are it. It's a good policy to put into place.
Debra Wright: So that was a very quick down and dirty of Section A, I will say, as as we ended with talking about policies and procedures
Debra Wright: on Friday we are doing a joint Webinar with Pain Act, which is the Pennsylvania Association of Nurse assessment coordinators, and Rkl, which is a consulting advisory firm, and they're going to talk more about processes to operationalize all of these changes. So that invitation and registration is part
part of our weekly newsletter. And I know there's been email blasts that are going out, but if you not received that yet and want to, I'm sure Kathy or Casey will tell you how to do that.
Debra Wright: I did drop in the chat because some people have been reaching out to ask what sections are going to be covered on what Wednesdays. I have a tentative plan, but I'm not sure how long each one will take, so there's a couple of weeks where? it'll just depend on how much timing we have where we end, and where we pick up the following week. But that tentative outline is in the. It's one of the things. It's the first thing in the chat. You can see that
Debra Wright: And at this point I think I will turn it back over to
Debra Wright: Casey and Kathy to see if we have any questions
Kasey Stevens | Quality Insights: fantastic. Thank you so much. Deb. in a moment. Here we're going to begin the Q. A. Section of our webinar. If you have a question or comment, please submit them, using either the chat or the Q. A. Feature, and I notice we already have a few in there. So far. So thank you all for those. You can also raise your hand to request to be unmuted, to ask your question out loud. I'd like to again invite everyone to next week's webinar, which we'll discuss the Mds changes in sections B, C. D. And E.
Kasey Stevens | Quality Insights: And we also invite you to bring your questions to our virtual live chat every Tuesday and Thursday at noon. Deb will be there to answer your questions on topics such as quality, improvement, initiatives, infection control, or Mbs coding. You can combine the links to those live tracks, chats, and our webinars in the Newsletter we send out each Friday, called the last minute low down. You want to receive that
Kasey Stevens | Quality Insights: newsletter, but don't think you're on the mailing list. Feel free to reach out to us. I'll add my email address in the chat, and we'll make sure you are subscribed to that. All righty, let's start with this question. Step
Kasey Stevens | Quality Insights: the first one. Will the webinar on the fifteenth be recorded for later viewing.
Debra Wright: Yes, yes. So, yeah.
Debra Wright: And then the question on the language portion of Section A does language include sign language?
Debra Wright: So here it says, an organized system of signing, such as American sign language can be reported as the preferred language, if the resonant needs or wants to communicate in this manner. So yes, if their primary source of communication is sign language, we should put in a a sl or American sign language whatever with them. Yes.
Kasey Stevens | Quality Insights: fantastic that that looks like all of our questions. Again, if you guys have any, follow up questions, feel free to reach out. We'll be happy to help you with those
Kasey Stevens | Quality Insights: before we sign up. We'd like to ask everyone to answer a Please A short evaluation of today's webinar. Evaluation is anonymous, and we'll show up as a pop out as soon as the webinar ends. You have a couple of minutes to take and fill that out. We'd really appreciate it. Deb. Thanks again for joining us today, presenting. We look forward to hearing from you next week again, and thank you all for joining us, and we look forward to seeing you again next week.
Debra Wright: and if anybody has any questions you can either raise your hand, or we'll be happy to stay on the line for a couple of minutes, and or you can come to our live chats Tuesday or Thursday at noon.
Debra Wright: Victoria, I see you have your hand raised.
Debra Wright: and I think, Casey, you have to
unmute her to allow her to talk.
Debra Wright: So she took her hand down.
Debra Wright: Will the same link link be used for each week's webinar. Yes, so if you have signed up for our Wednesday webinars, once you sign up for those it would be the same link every Wednesday. Yep.
Debra Wright: any other last minute. Questions?
Debra Wright: All right. Thank you. Everybody.