When you were a kid, do you remember the one kid that always changed the rules of the game while you were playing?
Well welcome to October first in the world of skilled nursing. Every year on October first there are changes to Medicare. It could be very drastic and extreme, or sometimes minor and easily adjusted for.
MDS
Usually the changes happen to the MDS or minimal data set for each assessment of a resident. It could be just one section or the change of a whole section.
Often theses changes are a direct correlation to payment for services. They are often “adjustments ” based on what was noticed from last year’s changes. This could be different questions or even eliminating questions.
The summary of the sections establish the payment rate for the resident.
Therapy involvement
A good thourogh evaluation from each discipline of therapy can significantly impact what the answers to each section should be and need to be added to the MDS. This is what assures that the facility will get credit and reimbursed for the care the resident actually needed.
However it seems like the comparison before of the kid that changes the rules as you go….If you get good at answering the right questions and having the data and documentation to back it up, the rules will change to make it more difficult.
All aspects of the team need to be involved
In order to capture everything that is done for someone there must be good documentation and data collection from everyone. It needs to come from CNAs, dietary, social work, and activities.
As we always say in rehabilitation, if you did not document it, it did not happen. So it is very important for all the team members to honestly answer the questions regarding what the resident needs.
Not all negative
There definitely has been some positive impact from recent changes on the typical cycle. Some further utilization of some services, as well as reimbursement for those services have come about.
Mental health is one of the realms of care for short term rehab residents that has had an increase due to capturing it on MDS.
Sadly many residents that need mental health services get far better care while under a rehab stay versus being home. They have access to not only medication management, but talk therapy also. It is unfortunate that many will not have continued care upon return to home.
Like a right of passage
So to those who work in this setting, here is to another year and another set of challenges. Luckily this is the usual routine and it will only be a matter of time until we master these changes and we move on to the next one. So cheers my friends. It is another year down and a new set of challenges. If we unable to be successful at mastering the details of MDS, they would never change the rules on us. So let’s go out an knock it out of the park.
