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MDS 3.0 The Old West Wisdom
Affinity Health Services, Inc. August 2010
Denise McQuown-HatterPresident
MDS 3.0
• Powerful document with implications for:– Resident– Families– Providers – (all providers)– Researchers– Policymakers– Regulators– Government Payers
“Love your enemies and keep your gun oiled”
Affinity Health Services, Inc. August 2010
Why MDS 3.0?
• Improvements over the current 2.0– Gives Resident Voice– Increases clinical relevance– Increases accuracy– Increases clarity– Reduces time to complete
“If your horse doesn’t want to go there, neither do you”
Affinity Health Services, Inc. August 2010
What does it mean to providers?
• Quality of Care• Proven tools and best practices
• Quality of Life• Resident Voice• I - Centered Care Plans
• RegulatorsDepartment of Health/QIS
• ReimbursementMedicare $$$
“Wearing gloves and button-fly jeans means you better think ahead”
Affinity Health Services, Inc. August 2010
State Veterans Homes - Specific
• MDS 2.0 versus 3.0• VA Data Collection/Benchmarking• Consistent with Mission/Resident Centered Care• Active Resident Counsel population• On-going software support• Funding Construction Grants that fosters resident
centered care“A word to the wise is unnecessary”
Affinity Health Services, Inc. August 2010
MDS/Reimbursement
• Certified versus Non Certified– MDS may look different in Certified
Homes/reimbursement guidelines must be met– Level of documentation
• Support the level of payment– ADL coding– Therapy– Significant Changes
– Policies and Procedures• Supports the survey process
“Never kick a cow chip on a hot day”
Affinity Health Services, Inc. August 2010
How do you plan to implement?
• START NOW• DEVISE A PLAN• Include in the Plan:
– Management training– Interdisciplinary Team training– Front line training– Include Resident’s Counsel– Include Family Counsels
“You don’t learn much when everything goes right”
Affinity Health Services, Inc. August 2010
The Softer Side of MDS Resident Voice – Person Directed Models• Communication
– Interview techniques – train staff – Customer Service– Private Interviews – location
• Psychosocial Well-Being• Activities of Daily Living• Activity Pursuit Pattern• Resident Participation in Care Planning
– Person conducting interview has to successfully communicate to the team
– Leads to I-Centered Care Plans
“The measure of a man is when he does the right thing even when no one is watching”
Affinity Health Services, Inc. August 2010
Resident Voice• How do your front line staff react?• How do we implement their wishes after
implementing the 3.0?• How are you currently implementing their
wishes?• How do you deal with your labor issues in terms
of flexibility with routines?• How far along is your home with resident
centered care?
“Some people grin and bear it. Other people smile and change it.”
Affinity Health Services, Inc. August 2010
I Centered Care Plans
MDS - Current• Considered as “added
paperwork”• Seems cold, harsh• Rush to complete the
document in the required time line
• “Mostly” Clinical Model based
“Nobody ever drowned himself in his own sweat”
MDS - Future• Set up appointment with
resident in advance – giving the resident control
• Accurate and more descriptive MDS starts a true resident centered care plan
• Active listening and resident/family participation
Affinity Health Services, Inc. August 2010
I Centered Care Plan
• A.M. / P.M. CARE: – I need extensive assist with my lower body care. I can take
care of my trunk and arms on my own if you set me up with warm water and a wet washcloth. I like to be near the sink and mirror to take my “sponge bath” every day. I get my hair done in the beauty shop every week. I don’t like it to get wet in between times. If my makeup is a little messy, please offer to assist me.
– Vs. Resident will have assistance with lower body care and will be provided with a wet washcloth etc.
“Go after life as if it’s something that’s got to be roped in a hurry before it gets away”
Affinity Health Services, Inc. August 2010
Thoughts to take home
• Take a care plan and remove all the patient and resident language and insert the residents name
• Video tape the care plan meeting for review by each of the caregivers
• Start the care plan on admission with admission personnel
“Some people follow wagon tracks while others break new trails”
Affinity Health Services, Inc. August 2010
Questions
Marcie Stoup - mstoup@affinityhealthservices.netDenise Hatter - dmh@affinityhealthservices.net
www.affinityhealthservices.net
Affinity Health Services, Inc. August 2010
“If life made sense, men would ride sidesaddle”
• Medicare A, B and D
– Its not all or nothing, but maybe something in between
Affinity Health Services, Inc. August 2010
Medicare Certification – Is it right for you?
• Medicare Part A– Discussion Points
• Admission Requirements• Available beds• Level of Care• Staff skill sets• Managed Care population
“You can’t keep trouble from visitin’, but you don’t have to offer it a chair”
Affinity Health Services, Inc. August 2010
Medicare Part B
• Predominately Therapy Services– Supplies– Vaccines– Equipment
• Therapy Options– Contract out the services – contractor bills – 0 cost to the
home– Certify as an outpatient clinic – bill for services
“Too much debt doubles the weight of your horse and puts another in control of the reins”
Affinity Health Services, Inc. August 2010
State Veterans Home Assumptions
• Similar in the fact that the shape of the Nursing Home Resident is changing– Higher acuity, shorter term, lower levels of care
• Services in lower levels of care can be handled differently with Medicare and other insurance dollars
• Pharmacy services – utilize Part D – contractor responsibility
“The quickest way to double your money is to fold it over and put it back in your packet”
Affinity Health Services, Inc. August 2010
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