MDS Coordinator - McKnight's Long-Term Care News Wed, 20 Dec 2023 19:26:38 +0000 en-US hourly 1 https://wordpress.org/?v=6.1.4 https://www.mcknights.com/wp-content/uploads/sites/5/2021/10/McKnights_Favicon.svg MDS Coordinator - McKnight's Long-Term Care News 32 32 “No man is a failure who has friends” — an MDS Merry Christmas https://www.mcknights.com/blogs/mds-intelligence/no-man-is-a-failure-who-has-friends-an-mds-merry-christmas/ Wed, 20 Dec 2023 19:26:29 +0000 https://www.mcknights.com/?p=142950 As Christmas and the new year approach, I get nostalgic. I like to think back on good old childhood memories. For me those are the 1970s and ’80s.

 I remember one Christmas, I was probably 7 years old, I wanted a child’s toolbox full of working tools like a kid-sized hand saw, screwdriver, wrench and a hammer. They all came in a metal toolbox that had a latch and a handle so you could carry it around.

I must have seen it in a store and asked for it, like Ralphie did with his Red Ryder BB gun. Lo and behold, on Christmas morning, there it was. I can still feel the elation of that moment. I also remember that in short order I was in the garage sawing up old cardboard boxes and making stuff that I proudly showed my parents. 

I hope you have memories like that. Just a few months before my mom passed away a few years ago, we all got out the photo albums and 8 mm films and reminisced about those days. It was a precious time I’ll never forget. Remember Clark Griswold in the attic

2023 has been a difficult year. The regulatory onslaught was brutal. But we are surviving. These challenges have also made me nostalgic. I often think about the day I made what I thought would be a temporary switch from acute care to long-term care. I became an MDS coordinator. A competent ICU step down nurse, I quickly realized I was out of my element in this new role.

In 2001, the MDS nurse was something new. PPS had just been initiated a few years earlier and the industry was still reeling. The MDS became electronic with that change and was required to be submitted to the state, via a modem. Do you remember the sound those things made? 

Quality Indicators, now quality measures, were new as well. No one really knew what was going on. Someone had to oversee it all. And so, the MDS coordinator position was born. 

Today there are a litany of resources available for the MDS nurse to rely on for advice and support. It is a wonderful thing to watch online communities take root and grow into vibrant discussions. Organizations like the American Association of Post-Acute Care Nursing (AAPACN), and others, have become the gold standard for educational opportunities and certifications. 

In those days, however, unless you knew someone who was also an MDS coordinator, there were relatively few resources available to answer questions and offer guidance. My paperback MDS manual was only a few hundred pages long and was scant on coding tips and clarifications. But those were the good old, “less complicated” days, remember? 

I also remember through the years those who helped me grow, many of whom have become career long friends. I remember my first administrator who had confidence that I could do the job. 

I remember several others I respected who came along, offered guidance, helped me gain confidence, and shed light on previously unrealized abilities. My initial nursing career plans did not include long-term care and these incredible people are the reasons I now do what I do. 

I came to understand through their compassion and care for this patient population, that the MDS and all it represents, is a powerful tool for good, that when a community of caregivers surround it and it is properly utilized, our residents are the beneficiary. What a joy!

As I think back, I am grateful for Randy Lewis, Joy Powers, Sandy Deakins, Mary Marshall, Diane Brown, Mendee Rock, Linda Estes, Manning McGraw, Sumit Malhotra and the many others who carried me along like a leaf on the river of this unexpected career.

Thank you also to McKnight’s Kimberly Marselas for reminding us of what it was like to have good friends by sharing this year’s Amazon ad, “Joy is shared,” in a recent article. I have a lump in my throat every time I watch it.

The RAI process is a wonderfully formidable task that cannot be accomplished alone. I hope that you have a circle of friends who help you grow and care about the MDS tasks you accomplish each day. Their support is indispensable. The outcome of those relationships will produce remarkable results, especially for the residents you care for.

Gracing our residents with those outcomes is the reason most of us do what we do in long term care.  Clarence the angel said it best to George Bailey in “It’s a Wonderful Life”: “No man is a failure who has friends.” 

I feel that intensely as I reminisce. How about you? 

Joel VanEaton, BSN, RN, RAC-CT, RAC-CTA, is a master teacher and the executive vice president of PAC Regulatory Affairs and Education at Broad River Rehabilitation.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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The MDS and Willy Wonka… chocolate anyone? https://www.mcknights.com/blogs/mds-intelligence/the-mds-and-willy-wonka-chocolate-anyone/ Mon, 13 Feb 2023 17:00:00 +0000 https://www.mcknights.com/?p=131832 February is a great month. It is a transition month in many parts of the country, from winter to the beginnings of spring. The sun is in the sky just a bit longer every day, and doesn’t forget the usual observances. There’s Groundhog Day, Valentine’s Day, President’s Day. It’s Black History Month and American Heart Month. 

There are also many lesser-known special days set aside in February, like Random Acts of Kindness Day, Periodic Table of the Elements Day, and Public Sleeping Day.

But did you know that February is also Celebration of Chocolate Month and that February 1 is Dark Chocolate Day? Well, now you do. I recently discovered this, and I know I plan to celebrate in future years.

I love chocolate in almost anything, especially dark chocolate. Sweet, rich, creamy, semisweet chocolate! I remember as a kid watching the original “Willy Wonka and the Chocolate Factory.” Remember the chocolate bar that Charlie bought that had the golden ticket in it? I was more interested in the chocolate than in the golden ticket.

It’s interesting what piques our individual interests and tastes. Many of us “MDS types” sort of fell into this career path, not by choice but by necessity. I confess that was me. Tired of nights, weekends and holidays at the hospital, I needed a break. Now, 23 years later, I can’t imagine doing anything else. 

So, with the sweet sentiments of this luscious month on my mind, I have been thinking about what it is about the RAI process that is so attractive to me and so many like me. I think much of it has to do with the fact that the RAI process is the nursing process. Do you nurses remember the old acronym, ADPIE? Assess, Diagnose, Plan, Implement, Evaluate. It was what I was taught and what resonated with me as a nursing student. 

I remember reading the RAI manual for the first time all those years ago and thinking, this is great! It fit me. Of course, it was a smaller paperback version then, but the foundation hasn’t changed with the accumulated added complexities over the years. We assess with the MDS, diagnose through critical thinking with the CAAs, plan with care plan development, implement the care plan and the process cycles as we evaluate with the OBRA schedule of assessments.  

In many ways, like Charlie’s golden ticket, all that’s been added to the MDS since OBRA ’87 is simply an adjunct to the basic goodness of the RAI process. Standardized assessment and care planning was designed to make quality patient care a requirement of participation and is the foundation… the delicious chocolate, if you will. 

Let’s savor that. It’s so easy to get caught up in the glamor of the golden ticket of PDPM and Five-Star ratings that we lose the simplicity of what the RAI was originally designed to do.

I confess, I’m guilty. I love the hunt for the golden nuggets of PDPM and state case mix, as well as the thrill of seeing a Five-Star rating improve. But, perhaps a return to the basics will make the other parts of the process much more valuable. 

We are in unprecedented times. Quality MDS coordinators are hard to come by. New MDS coordinators are expected to hit the ground running with all pistons firing at full speed. The pressure is intense, and burnout is inevitable. A return to the basics might just be the ticket to MDS coordinator satisfaction and longevity. We are nurses, after all.

I am not saying that the residuals accomplished by a well thought out, accurate, timely MDS assessment are not important. They absolutely are. 

What I am saying is that an accurately completed, critically thought-out RAI should lead to the desired representation in the Five-Star, PDPM and case mix. Shouldn’t it? If our MDS coordinators were given the latitude to really understand and complete the RAI as it was designed, then the adjunct “golden tickets” would invariably be found.

I really enjoy teaching all things MDS. As a Master Teacher with AAPACN, I regularly have the opportunity to teach advanced students. However, when I see a new MDS nurse begin to understand the value of what they do and how an honest understanding and utilization of the nursing process is what the RAI is all about, I am delighted. 

In the end, Charlie’s golden ticket was just a wrapping that allowed a fuller experience of the magical Willy Wonka chocolate factory and the confectionary delights that were produced there. Ultimately, it was Charlie’s basic honesty that won the day and afforded him and his family the grand prize of owning the chocolate factory.

February is a great month. Enjoy the special days, and the chocolate. There is much to savor. Honestly, the reward can be truly satisfying.

Joel VanEaton, BSN, RN, RAC-CT, RAC-CTA, is a master teacher and the executive vice president of PAC Regulatory Affairs and Education at Broad River Rehabilitation.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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MDS coordinator strain hits nursing facilities where it hurts most https://www.mcknights.com/news/mds-coordinator-strain-hits-nursing-facilities-where-it-hurts-most/ Tue, 28 Jun 2022 22:30:07 +0000 https://www.mcknights.com/?p=123305 A nurse works at a computer
Credit: The Good Brigade/Getty Images Plus

Labor shortages are costing providers deeply, but new data finds workforce issues are also impeding their ability to collect payment for services they’ve already delivered.

Challenges including turnover among reimbursement staff, more time spent on the floor by nurses in reimbursement positions, and less-experienced new hires are “negatively impacting revenue potential,” according to a survey published Tuesday.

Market Report: The State of SNF Clinical Reimbursement found 90% of skilled nursing providers polled had issues with MDS coordinators and other billing staffing that were affecting their ability to collect. Some 57% had turnover on their clinical reimbursement team within the last six months.

“Resource strains have a ripple effect that impacts reimbursement beyond census,” said Ryan Edgerly, CEO at MedaSync, a software provider that cosponsored the survey with rehab firm HealthPRO Heritage. “We hear these scenarios all the time. A lack of frontline caregivers causes MDS coordinators to work the floor more and more, giving them less time and attention to get their reimbursement responsibilities right.”

Those demands, unrelenting during COVID and ongoing nurse shortages, are also pushing more reimbursement pros to leave the field, switch employers or return permanently to frontline nursing, adds Rosie Benbow, an MDS consultant and owner of Leading Transitions Post Acute Care Consultation and Staffing.

She’s seen the average salary for MDS coordinators increase from $60,000 to $65,000 annually, to $78,000 to $80,000 annually among clients she serves in Indiana, Michigan and Wisconsin. Still, that’s not enough to stop workers from leaving — and from taking valuable knowledge and experience with them.

Finding a replacement or committing to training someone fresh to the role isn’t any easier than retaining coordinators, Benbow told McKnight’s Long-Term Care News Tuesday.

“The absolute biggest challenge is availability of a trained nurse,” she said, noting that one client has been using her as an interim coordinator for more than a year while searching for an experienced replacement. “People feel like they need that fully trained person so that they don’t lose on the reimbursement, but you struggle to get that.”

Managed care adding to challenge

The job has become harder in recent years in more ways than just COVID and smaller teams. The rise of managed care, plan levels, the switch to the Patient Driven Payment Model and state variations in case-mix calculations are all adding to the complexity of the job.

More than half of the Market Report respondents cited an increase in managed care penetration and Medicaid rates as a chief concern. When asked to rate their level of concern about their ability to prevent missed reimbursement “in a multi-payer universe,” 65% categorized themselves as moderately or very concerned.

Half said an increase in managed care penetration was their top concern, followed by Medicaid rates at 46%. PDPM, however, only ranked 6th on the list,  despite a survey window that coincided with federal officials’ announcement that they planned to trim PDPM next fiscal year.

Managed care denials and other payer factors, combined with inexperience or lack of training, may mean more opportunities to miss out on earned reimbursement. 

Benbow estimated medium nursing homes could lose $150,000 to $200,000 quarterly because of missed diagnoses, poor PDPM calculations, a drop in case mix or financial penalties tied to quality reporting errors. 

“It is definitely a struggle just to deal with managed care,” she said. “Another struggle of our time, outside of the staffing itself, is trying to keep up with all the angles, depending on what state you’re in.”

She encourages facilities to make a quick decision on filling a vacant MDS coordinator role – even if that means taking a savvy nurse off the floor. But the facility must then give that nurse side-by-side training for weeks, possibly months, with in-house audits and external reviews to make sure dollars that are due are actually being collected.

Providing support through technology and consulting, she said, is likely to pay off in the long run.

“Some folks don’t want to invest as much in their own financial future,” Benbow said. “Others absolutely do, and they see the value in weekly or monthly reviews to help catch opportunities.”

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The remote solution https://www.mcknights.com/blogs/guest-columns/the-remote-solution/ Mon, 13 Jun 2022 16:00:00 +0000 https://www.mcknights.com/?p=122817
Michele A Lynch

Amid the ashes of the COVID-19 pandemic came the realization that there were more casualties from this plague than we thought. 

It was reported that 25% of COVID-19 deaths were long-term care residents and staff. But an event that’s receiving less coverage is the mass exodus of long-term care employees, especially nurses. Ninety-nine percent of nursing homes in the United States are now reporting staffing shortages, according to the American Medical Association.

Who are the 1%, I wonder? What are they doing right? What are the other 99% doing wrong?

As a result of the staffing crunch and the pending changes at the Centers for Medicare & Medicaid Services, it has been particularly difficult for clinical reimbursement departments. Never before have I seen so many MDS coordinator/clinical reimbursement/care planner positions available. 

Many MDS coordinators have been pulled to the floor to provide care or test residents and staff. Many more have retired or resigned, leaving empty chairs and piles of uncompleted MDS assessments and care plans. Ultimately, the Quality Measures will fall, the survey tags will be plentiful, and reimbursement rate reductions are a real possibility. 

Many of those who fled during this mass exodus from MDS Land gave a multitude of reasons for their departures on social media. It was too much for one person to do. No vacations. No backup assistance. The desire to work remotely.

The solution? Remote clinical reimbursement services have popped up, offering a plethora of services, including MDS completion, Quality Measure reviews, care planning, case management, audits and more — the list is growing.

The upside? A remote employee requires no office, no electricity, and in this field, little to no orientation. They do not collect benefits or require unemployment insurance. Remote MDS services are typically less expensive than agency or interim services. Depending on the company you select, you can use them as little or as much as you want, as some offer short and long-term contracts. They typically work from home and have little to no distractions while figuring out your optimal reimbursement rate or seeking out those coveted NTAs.

So while no remote service can take the place of an MDS coordinator in the facility, very few MDS coordinators want the challenge of a building whose RAI assessments are months behind. Especially with the additional duties that are now being assigned to the clinical reimbursement department.  Annual survey could be a nightmare with multiple tags for late or missing assessments, incomplete or inaccurate care plans, missing baselines and more.

It is only one solution to an ever-growing pile of problems facing the LTC industry, but it’s a start. And if major companies like Apple, Google and Facebook found a way to make remote roles work, I am certain long-term care will find a way as well.

Michele Lynch, RN RAC-CT DNS-CT, has been a registered nurse for nearly 30 years with most of that time spent in long-term care, including time as a floor nurse, supervisor, and MDS coordinator. She currently works for a faith-based facility in St. Petersburg, Florida, in addition to remote roles with Citadel and Remote Solutions CRP LLC.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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The ballad of the MDS coordinator https://www.mcknights.com/daily-editors-notes/the-ballad-of-the-mds-coordinator/ Mon, 08 Jun 2015 10:30:00 +0000 https://www.mcknights.com/2015/06/08/the-ballad-of-the-mds-coordinator/ Like I hope for many of you, I appreciate the hours before 6 a.m. as ones in which I am asleep.

Apparently there is a subset of MDS coordinators using these pre-dawn hours to sneak into their skilled nursing facility so that they can work in peace and quiet. That’s one of the first of many tantalizing tidbits I picked up during the first day of the NADONA LTC (National Association of Directors of Nursing Administration LTC) conference, specifically through a session on MDS 3.0 Accuracy Survey Process given by Leah Klusch, RN, BSN, executive director of the Alliance Training Center.

While the presentation focused on preparing documentation and audits, she spent time diving into the way MDS managers are treated — and it doesn’t look great.

She said many times she’s walked into a facility and asked the administrator the name of the MDS coordinator —and he couldn’t quite remember. “Take me to her/him,” Klusch will say, and he/she will say, “Let me get someone.”

“That MDS manager is writing your paycheck,” she reminded sternly. The MDS 3.0 gives the outside world a picture of the SNF, and it is unacceptable for administrators to be removed from the day-to-day lives of the people making this happen.

“Don’t tell me you don’t know where they are, or that they have one phone line, or you can’t afford to buy them a new computer,” she said. “Or that they share an office with the activity coordinator.” They are coming in at 4 a.m. so they can have a quiet office, or working weekends, or 14-hour days, she said. Also, I’m not sure I entirely understand why so many MDS offices have a refrigerator, but apparently this is a thing Klusch sees, and my sense is she would like to drag it out of the office with her bare hands and put it in the administrator’s office. Consider this your warning.  

Too many MDS nurses and RN assessment coordinators are being bled through a tiny thousand paper cuts or indignities such as what’s above.

There’s a lack of understanding of how important it is to have proper levels of staff in this area, because tired and burned out MDS coordinators make mistakes. Klusch said one facility instituted a policy that no one could code after 3 p.m. She also reminded that an RN assessment coordinator is required, and it cannot be an LPN/RVN in most states.

Another piece of advice was around passwords: MDS nurses need to have a secure password sharing system or leave instructions as to where these passwords are kept. Klusch told a story about a system where the two MDS coordinators were hit by a truck, and no one else had the passwords to any software system or CASPER. The building lost almost $300,000 while the staff waited — and prayed for — the nurses to recover.

The total message was overwhelming for some nurses, and it caught some off-guard compared to NADONA sessions that are designed to be more about morale or team-building. It’s good to balance that out with nitty-gritty parts of the job. While Klusch compared reviewing the accuracy and survey process as cleaning out one’s closet, an attendee near me murmured that she thought it sounded more similar to a colonoscopy. 

In both cases, though, the metaphor is clear: The junk has to be cleared out.

Elizabeth Newman is Senior Editor at McKnight’s. Follow her @TigerELN.

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Ask the payment expert … about MDS staffing https://www.mcknights.com/news/ask-the-payment-expert-about-mds-staffing/ Wed, 04 Sep 2013 17:00:00 +0000 https://www.mcknights.com/2013/09/04/ask-the-payment-expert-about-mds-staffing/ We recently lost our MDS nurse and didn’t know what to do, as no one else knew how to do MDSs. What should we do differently now?

As you have now learned, having back-up for your MDS staff is essential in today’s PPS environment. The process has become so time critical that you can’t afford to only have one person trained in the MDS process.

The ideal is for multiple people to be proficient in the process such as each nurse manager doing his or her own assessments. That is not always possible. It is essential, though, that nurse managers participate in the process so that they understand correct coding of the MDS and they can step in when needed to complete assessments. 

Recently, a client’s MDS nurse left with no notice. This facility had no one in the facility who was trained in the MDS process. They had two choices: Hire a temporary MDS nurse or suffer the financial consequences of not having timely completed assessments. Another facility has had multiple changes in its MDS nurses. This has resulted in missed and late assessments.

Here is the solution: Make sure that you always have a back-up plan. This must be an uninterrupted process. Train more than one person in the MDS process. You still might want your main MDS nurse concentrating on coordination of processes (e.g. scheduling, ARD management, communication with therapy, etc.) but not being the only one completing the process.

One strategy is to have your nurse managers complete comprehensive assessments because those are the ones that drive the care planning process, and have your MDS nurse complete the other PPS assessments. That way the right nurse is doing the right assessment and you will always have multiple nurses who can step in when needed.  

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Ask the nursing expert … about transitioning to DON position, staying abreast of MDS changes https://www.mcknights.com/news/ask-the-nursing-expert-about-transitioning-to-don-position-staying-abreast-of-mds-changes/ Mon, 05 Aug 2013 20:00:00 +0000 https://www.mcknights.com/2013/08/05/ask-the-nursing-expert-about-transitioning-to-don-position-staying-abreast-of-mds-changes/ I have just been promoted to director of nursing after the position became available. I am very nervous. Where do I even start and where would I find support and continuing education for my new role? 

Congratulations on your new promotion! Usually, companies provide regional nurses for support. Ask your regional nurse if you can spend some time with other DONs in the company to observe how they manage company expectations. 

Develop your own nursing philosophy for your nursing team. Have a meeting with current nursing leadership: ADON, nurse managers, QA, staff development, infection control and any other key positions to discuss department goals and expectations. 

Then meet with units around the clock to discuss what you have developed. Talk of professionalism such as nursing uniforms, attitude and customer service. Demonstrate your professionalism through frequent rounding and by remaining approachable for staff. Join an organization that focuses on LTC and/or directors of nursing. This should get you started.

How do I stay on top of the many changes occurring within the MDS process? 

My first recommendation is that you get certified in the MDS through the American Nurses Credentialing Center. Staying on top is a challenge with all your other responsibilities, but you will keep your sanity by doing so. 

Your facility should receive continuing education information when workshops are being offered. Let your MDS coordinator know that you are interested in remaining up-to-date with the MDS process. 

Remember that the accuracy of the MDS process is under the oversight of both the administrator and director of nursing. You will do fine. 

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Association defines role of LTC nurse assessment coordinators https://www.mcknights.com/news/association-defines-role-of-ltc-nurse-assessment-coordinators/ Thu, 02 Jun 2011 10:30:00 +0000 https://www.mcknights.com/2011/06/02/association-defines-role-of-ltc-nurse-assessment-coordinators/ The American Association of Nurse Assessment Coordination issued a white paper Wednesday that officially defines the role of nurse assessment coordinators in long-term care facilities.

Under AANAC’s new definition, nurse assessment coordinators “promote and embrace person-centered care; improve the quality of care for residents through better communication strategies; and are responsible for collecting health data that is used to create effective care plans and prevent complications and rehospitalizations.”

The Omnibus Budget Reconciliation Act of 1987 created the role of the nurse assessment coordinator. Since then, that job title often has been referred to as MDS Coordinator. These LTC professionals typically are responsible for completing resident assessments for reimbursement and care management purposes, as mandated by the federal government. But until now, there has not been a formal definition of these coordinators’ duties or performance expectations, AANAC said.

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