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Guilt-Free Getaways for MDS Coordinators

June 1, 2004
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MDS coordinators can take vacations, too-it's just that they have to plan more carefully than most by Jennifer Gross, RN, BSN, and Steven B. Littlehale, MS, APRN, BC

Guilt-free getaways for MDS coordinators

Just because the MDS never takes a vacation doesn't mean you can't It's summertime! The days are longer, the weather is sunny and warm, and most people are planning their summer vacations. But for many MDS coordinators, vacation time is often a time of anxiety and guilt. "How can I take a vacation?" they ask. "No one else will do my job while I'm gone." Well, take heart, weary MDS coordinators; we can help you make your time off guilt-free. Our four easy steps will ensure that your vacation will not put your facility at risk for late or lessened reimbursement or survey deficiencies-specifically:
  1. Work those dates.
  2. Back yourself up.
  3. Be an early bird.
  4. Leave a wake behind you.
Work Those Dates
Before you buy that perfect poolside ensemble, a quick review of the scheduling requirements mandated by CMS is necessary. The required MDS assessment schedule (including completion and transmission requirements) is summarized in the RAI Manual, Version 2.0 (August 2003, p. 2). The following list spells out the maximum number of days allowed between assessments:
  • The Admission assessment (AA8a=01) must be completed no later than day 14 of admission, with the first day of admission counting as day 1.
  • Following this, each Quarterly assessment (AA8a=05) is due for completion no later than 92 days after the previous assessment's R2b date (date of completion).
  • Annual assessments (AA8a=02) must be completed no later than 366 days after the completion date of the previous comprehensive assessment. The specific MDS data field used to count this is VB2 (Date of RAP assessment process).
  • In addition, care plan completion or revision must be within 7 days of this RAP completion date (VB2).
  • CMS requires an MDS assessment every 92 days. They use the R2b date to count off the 92 days, not the Assessment Reference Date (ARD), as is often erroneously assumed.
  • Additionally, CMS looks for a comprehensive assessment every 366 days, and the VB2 date is used to count off these days.

The "MDS clock" is reset whenever a new completed assessment is submitted; thus, the next assessment is due based on the R2b date of the most recent assessment.

In addition to the requirements for OBRA assessments described above, Medicare MDSs have a higher frequency of required assessments, each with its own ARD window. Each of these assessments must be completed (R2b) within 14 days of the ARD. If an assessment is dually coded as Medicare and OBRA, then both sets of rules must be followed; to be compliant with both, always choose the most stringent. For all assessment types, data entry and transmission to the state must be completed within 31 days of the completion date of the MDS.

As you can see, you have to deal with a strict timeline, which can lead to F-tags on surveys as well as financial penalties if the submission process falls behind. Unfortunately, the realities of working in a nursing home sometimes interfere with the timely completion of MDS assessments. Staffing issues often result in MDS coordinators being pulled from their jobs to work on the floor. Sick days are often unavoidable. And, yes, MDS coordinators get vacation time, too! But how can you take the time off you're entitled to while maintaining compliance with your MDS schedule?

Back Yourself Up
MDS coordinators are a "rare breed" in each facility. Most facilities have only a few MDS nurses, with one person coordinating the process. Many homes have only one person doing the MDS scheduling, coordination, data entry, and transmission. You may prefer to say, "The buck stops here" with the MDS and be in charge of the resident assessment process, but there are times when it may be necessary for you to have some backup. Consider taking some time to train one or two coworkers in the MDS process and be sure that your director of nursing is involved. Remember that CMS rules don't specify who actually completes the MDS, only that an RN coordinates the process. The team approach is a very important factor in keeping the MDS ball rolling. If you have difficulty compelling staff to be cross-trained in MDS, a few well-placed comments to the administrator or CFO about a "single point of failure" and common "dips" in RUG scores and CMI occurring during summer holidays might raise an eyebrow.

Be an Early Bird
Once you have reliable backup in your facility, you can keep up to date with MDS submissions, even in the case of an emergency leave. Now you can begin to plan ahead for that much-needed vacation! To do this, you need to consider what can and can't be flexible in the MDS schedule.

First, though, a word of caution: MDS schedules should not be "played with" on a regular basis merely as a matter of convenience. Our advice is meant for nonroutine situations, such as planned time off for vacations or medical leaves. For example, if you have a Medicare resident who will be due for a 30-day MDS while you are in the middle of your Caribbean cruise, you and your team will need to plan ahead to make sure that the MDS is in compliance and accurately reflects the resident's acuity.