1. MDS 3.0 – Becoming a Reality October 1, 2010
Presented to:
MDS 3.0 National Train the Trainer Conference
April 12-15, 2010
Baltimore, MD
Thomas Dudley, MS, RN
Centers for Medicare & Medicaid Services
Office of Clinical Standards and Quality
Quality Improvement and Health Assessment Group
Division of Chronic and Post Acute Care

2. Let’s Address a Couple of Things Before We Get Started
An updated version of the instrument and manual will be published on the MDS 3.0 page of in late May or early June.
The taped version of this training conference will be published on in late May or early June.

3. Let’s Address a Couple of Things Before We Get Started (cont.)
Comments and questions can be submitted to
The transition to MDS 3.0 is a TEAM effort and together WE will successfully make it through the change.

4. Let’s Address a Couple of Things Before We Get Started (cont.)
Yes, the new MDS 3.0 instrument will be challenging at first, but keep in mind that MDS 2.0 was challenging at first. Change is hard, but change is good!
“Perfect” doesn’t exist, we strive for perfection, but inevitably there will be hiccups. We all need to be patient as we work through the change together.

5. Topics to be Covered History of MDS Why the Change to MDS 3.0?
MDS 3.0 Timeline
MDS 3.0 Training – Now and Beyond
Quality Measures and Public Reporting

6. Why MDS? Simple answer: Because the law says so
Omnibus Budget Reconciliation Act of 1987 is the
Statutory & Regulatory Basis for the RAI
To provide a comprehensive, accurate, standardized, reproducible assessment of each resident's functional capabilities
To help staff identify health problems
Balanced Budget Act (BBA) of 1997
Established the Skilled Nursing Facility (SNF) prospective payment system (PPS).
Required CMS to create a set of a national minimum set of standards of care and rights for people living in certified nursing facilities.
Required the development of uniform certification standards for Medicare and Medicaid homes.
Required CMS to develop a Resident Assessment process for the creation of individualized care plans for nursing home residents. The instrument is referred to as the Resident Assessment Instrument (RAI).
Created the requirement for nurse staffing information and nursing facility survey results to be made available to the public.
BBA 1997:
Established the Skilled Nursing Facility (SNF) prospective payment system (PPS).
PPS payment rates are adjusted for case mix and geographic variation in wages and cover all costs of furnishing covered SNF services (routine, ancillary, and capital-related costs).

7. History Lesson October 1990 – Effective date for the RAI
October – Development of the RAI Began (HCFA established contracts with RTI, the Hebrew Rehabilitation Center for Aged, Brown University & the University of Michigan)
October 1990 – Effective date for the RAI
April 1995 – MDS 2.0
April 1995 – Present – Instrument has remained relatively static

8. Official Uses for MDS Survey and Certification - December 1990
Care Planning - December 1990
Survey and Certification - December 1990
Payment/Electronic Submission - June 22, 1998
Nursing Home Quality Initiative/Public Reporting - November 2002 and the QIO Scope of Work

9. The true intent of MDS is….
To make CMS happy? NO
To give NH providers something to do?
To give surveyors something to do?
To make sure providers are paid properly?
YES
To make sure NH Residents are receiving appropriate care?
ABSOLUTELY YES
To provide NH providers with a tool to assess the status of their Residents in order to appropriately develop plans of care to optimize quality of life?

10. Why MDS 3.0? Why not? MDS 2.0 is outdated
MDS 2.0 isn’t consistent with current clinical practices
MDS 2.0 has limited value to NH’s outside of it being a required assessment

11. Timeline March 2010 April 2010 May Summer 2010 September 30, 2010
QMs Submitted to NQF
RAI Training
April
2010
National Train the Trainer Conference
May
Revised RAI Manual, Technical Specifications, and Educational Materials to be Published
Summer 2010
Tentative – Additional training opportunities (e.g. Satellite Broadcasts)
September 30, 2010
MDS 2.0 is sent to the land of retired assessment instruments.

12. Timeline October 1, 2010 December 2010 January 2011
…and then there was MDS 3.0
December 2010
Anticipated NQF endorsement of NH measures mapped to MDS 3.0
January 2011
Last MDS 2.0 QM update on NHC
April 2011 – Spring 2012
QM data and 5-Star data on NHC????
April/May 2012
New MDS 3.0 QM data published on NHC

13. Official MDS Information and Training Materials
SNF/LTC ODF
MDS 3.0 Website

14. MDS Web-Based Training
Available ~May-June 2010
To be available online 24/7, 365 days/year
Exactly the same content that was available at the National Train-the-Trainer Conference

15. Nursing Home Quality Measures
Will include Post Acute and Chronic Care Measures
New measures will replace existing measures (or at a minimum modify the existing measures based on the MDS 3.0 Instrument)
18 Candidate measures submitted to NQF
Ultimately the measures will be published on Nursing Home Compare

16. Measures for Possible Retirement
MDS 2.0 Quality Measures Recommended for Retirement/Replacement
PAC
Chronic
Potential Replacement
Delirium X
Delirium (new PAC measure)
Mobility decline
‘Ambulation’ (PAC and Chronic)
Pressure ulcers (low risk)
Bedfast

17. Candidate Measures Submitted to NQF
Summary Table of 18 Measures Submitted to NQF for Endorsement
PAC
Chronic
Five-Star Item
Percent of Residents with Pain X
Delirium (replacement measure)
Percent of Short-Stay Residents with Pressure Ulcers That Are New or Have Not Improved
Percent of Residents Who Were Assessed and Given Pneumococcal Vaccination

18. Candidate Measures Submitted to NQF
Summary Table of 18 Measures Submitted to NQF for Endorsement
PAC
Chronic
Five-Star Item
Percent of Residents Who Were Assessed and Given Influenza Vaccination X
ADL decline (replacement measure)
Mobility decline (replacement w/ focus on ambulation)
Percent of Long-Stay, High-Risk Residents with Pressure Ulcers

19. Candidate Measures Submitted to NQF
Summary Table of 18 Measures Submitted to NQF for Endorsement
PAC
Chronic
Five-Star Item
Percent of Long-Stay Residents Who Were Physically Restrained X
Percent of Long-Stay Residents Who Have/Had a Catheter Inserted and Left in Their Bladder
Percent of Long-Stay Residents with a Urinary Tract Infection

20. Candidate Measures Submitted to NQF
Summary Table of 18 Measures Submitted to NQF for Endorsement
PAC
Chronic
Five-Star Item
Percent of Long-Stay, Low-Risk Residents Who Lose Control of their Bowels or Bladder X
Percent of Long-Stay Residents Who Lose Too Much Weight
Percent of Long-Stay Residents Who Have Become More Depressed or Anxious

21. Just the Facts… Yes, this applies to everyone.
Yes, October 1, 2010 is the implementation date.
Yes, this applies to everyone.
Yes, all of us will survive the change to MDS 3.0.

22. What’s Next?
Additional QMs
Modifications to the MDS instrument to keep pace with changes in clinical practices
MDS 4.0, Continuity Assessment Record and Evaluation Instrument (CARE), or EHRs?
CARE (Continuity Assessment Record and Evaluation).The CARE instrument, with a standardized set of data elements, enables a variety of health care providers to uniformly measure and compare Medicare beneficiaries’ health and functional status across settings, over time. CARE and its supporting application will allow authorized clinicians, with a need to know, to electronically view their patients’ recent medical history (from the previous setting) and allow them to record and rapidly communicate their patients’ current health status to the next care setting.

23. Questions?

24. Thank you and enjoy your stay in Baltimore.
General Comments or Suggestions can be submitted to: Or
Specific Questions can be submitted directly to me: