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MDS 3.0 survival guide

May 1, 2010
by Dave Wessinger
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What administrators, directors of nursing need to know

Long-term care providers are bracing themselves for substantial change pending the arrival of MDS 3.0, slated for October 1 of this year. While daunting to most providers, proper MDS preparation can turn what was once a potentially costly mandate, into an opportunity for greater organizational change.

The Centers for Medicare & Medicaid Services (CMS) training, and the technology supporting the transition to MDS 3.0, comprise the two largest elements of this preparation.

CMS training

CMS has published a timeline of upcoming conferences, training, and manuals to educate providers in the tactical rollout of the new MDS 3.0 assessment and data collection criteria. Provider participation in CMS training activities will prepare them for the significant changes between MDS 2.0 and 3.0. Among these changes, significant highlights include:

  • Introduction of the Resident Interview Process. Resident participation in key care areas will enable facilities to take a more resident-centered approach to care in these areas.

  • Therapy Minutes Refinement. Additional therapy minute classification for the capture of therapy delivered concurrently to two residents. This is then used as part of the RUG-IV refinement to more accurately reflect the level of services provided and reimbursement to be provided based on that level of service.

  • Expansion of Wound Care Information. Capture of wound information has been significantly expanded in the MDS 3.0. While this additional information is not used for RUG-IV classification, it does represent the importance that proper wound identification and staging plays in the survey and certification process.

  • Restorative Nursing. Information capture for the delivery of these programs is expanded and now used as part of the RUG-IV calculations, along with activities of daily living and depression, to appropriately classify residents in a RUG group.

  • Look-Back Periods. The look-back period for MDS 3.0 items has been updated to reflect only the seven days prior to the Assessment Reference Date and cannot include information from the stay prior to the resident entering the facility.

At a glance…

Effective preparation for MDS must include the design of a technology plan. Those that critically evaluate and invest in their ability to address the upcoming demands of MDS 3.0, will not only enjoy a successful transition in October, but may also find that they've achieved a new level of operational excellence.

Information on the upcoming CMS MDS 3.0 National Train-the-Trainer Conference is available at


In addition to understanding the fundamentals of the assessment, a successful transition to MDS 3.0 requires the careful evaluation of supporting technology. In the months prior to October, a technology plan should be designed to prepare for the implementation and expense of MDS technology updates.

Implementation: The timely implementation of technology is vital to the success of the provider. A lagging deployment of MDS 3.0 software presents the risk of inaccurate assessments and errors or delays in reimbursement submissions, resulting in a devastating impact to cash flow.

Careful planning is the best defense against implementation disruption. In circumstances where the provider is responsible for installing the MDS 3.0 update, planning must include scheduling of appropriate onsite information technology resources, an assessment of hardware requirements, and months of testing time, long before the October 1 deadline. Providers with hosted solutions, including the automated delivery of the 3.0 update (no installation and very little testing) should plan to use similar amounts of time to familiarize MDS nurses with any upcoming changes to the technology.

Expense: Providers must plan for unavoidable staff training expenses related directly to the MDS 3.0 mandate. Related costs, and the provider's ability to contain them, will vary depending on the type of solution.

Technology training costs should be measured against software ease of use. If existing technology has proven difficult to learn in the past, greater expense and ramp-up time must be allocated to staff training. Inherently intuitive technologies will require far less education expense for both MDS 3.0 and future regulatory and compliance mandates.

Capital costs resulting from an MDS 3.0 upgrade can include software, installation services, testing, and support. In certain cases, consulting costs may also be required to manage integrations between the MDS and downstream functions (e.g., Billing). When designing the technology plan, many providers leveraging hosted technologies supporting all related MDS functions (Clinical and Billing) will be able to avoid most, if not all, of these costs. Other technologies may include most or all capital cost items.

A catalyst for change

For many proactive providers that have scheduled CMS training and constructed a solid technology plan, MDS 3.0 has become a catalyst for considerable organizational change. Using the valuable time until October's deadline, investments are being made to automate manual processes through technologies like Point of Care (POC) and electronic Medication Administration Records (eMAR). These types of investments not only streamline operations, but also reduce costs and maximize reimbursements.