Organizing the MDS office
With the many changes in the assessment process and data collection following conversion to the MDS 3.0, facility administrators need to focus on the efficiency, location, and resources of the MDS office. The implementation of the new process has produced new assessment activities, many new tests, and more specific time requirements. New data requirements, (e.g., the focus on interviews and resident voice), compel staff to complete assessment tasks before the end of the assessment reference period.
While the background, training, and skills of the MDS manager are very important, so too are the workspace, equipment, software, and supplies that contribute to the overall efficiency of the process. The facility must achieve a significant level of efficiency to facilitate compliance within the structure of the process and allow for appropriate transmission and validation of the data sets.
Historically, the MDS office has not been a focus of operational professionals and subsequently often features outdated hardware or equipment that could diminish its efficiency. My first suggestion is that administrative managers carefully assess the office’s strengths and weaknesses. Consider factors like lighting, workspace, seating comfort, filing capabilities, privacy, a quiet atmosphere for data entry and editing, storage space for documents (validation reports and schedules), meeting space for contacts with the interdisciplinary team (IDT), and hardware capacity.
Frequently the MDS manager’s workspace is not in a separate office. Often, it’s one of the staff social hubs because the MDS manager interacts with so many people during the data collection and formulation process that the traffic becomes a distraction. Often phone lines are limited, preventing efficient communication between staff members. Adequate workspace to review medical records and assessments completed by IDT members is necessary and frequently limited or just not available. This creates a crowded workstation with poorly organized parts of charts and assessments, which can lead to delayed completion or duplicated assessment tasks when reports are misfiled, lost, or simply not accounted for.
I suggest that you locate the MDS office close to management, admissions, and billing because communication between these departments is essential to manage the flow and assessment activity. The MDS nurses must have access to the IDT for both planned and unplanned communications and meetings. Many MDS nurses have found that having a whiteboard in the office is helpful for schedules, notices, and planning.
The MDS manager and MDS nurses need adequate workspace for their computers and the documents they use to validate and finalize the 3.0 data sets before transmission. Without transmission and subsequent validation, the MDS record is not final-not finished, and therefore cannot be billed. Where and how do we produce this final assessment copy for transmission? The MDS 3.0 assessment process feeds into a new data set, in new software with new requirements for validation. The MDS manager must be able to work with the data sets and concentrate on all the changes, definitions, and timelines. The manager requires an orderly, efficient, well-lit, and quiet atmosphere in which to work. So how does your MDS office measure up?
What is an organized office worth to the facility, its ownership, and management? A lot. These data sets are writing your payment checks from Medicare, Medicaid in most states, and other sources. Accuracy and validity of the data set documents is essential. Remember, most of the process and all the software have changed and the schedule is more demanding, requiring more communication and data reporting in a shorter period of time. If the MDS manager cannot concentrate on coding, does not have adequate space to review charts and assessments from members of the IDT without interruption, cannot easily communicate with other departments because of a lack of phone lines or e-mail for instant notification, the process will result in more frequent errors and the data set could be more difficult to validate. So what? Well, a delay beyond the 14-day transmission deadline could produce a default rate or, if the assessment is being completed at the beginning of the month on a previous month’s Part A stay, a delay in billing could result. With all the new processes the MDS manager must deal with, a quiet, comfortable, well-ventilated and properly illuminated office will foster more efficiency and accuracy.
The size, type, and efficiency of hardware the nurses use to input the data into the program needs to be evaluated to facilitate navigation of the system during the data entry process. Long wait periods between section completion or having to re-enter the assessment to navigate back to a previous section is simply not acceptable. The software needs to be a tool, not a barrier to efficiency.
Senior managers-both operational and clinical-need to monitor the actual MDS schedule and completion data. The number of assessments completed, transmitted, rejected, and validated by the day or week needs to be reported and considered as they relate to the efficiency of the process. A surge in admissions or readmissions will have a significant impact on the workload and timelines for compliance. Software performance must be evaluated at least weekly at this time, and regular communication with the vendor should be established so if problems are identified they can be addressed immediately.
In the past system we were able to muddle through and still get paid, be mostly compliant, and not make too many investments in our systems or equipment unless something broke down. Today we are looking at much more data, higher regulatory scrutiny, short timelines for transmission, increased assessments and tracking documents as well as many new definitions impacting documentation and data collection. And today, if you are a day late you may be more than a dollar short. Errors in transmitted data will not be tolerated by the intake system, so rejections will increase and produce more stress on the facility process with re-transmissions.
So many facilities without efficient, well-managed, and monitored processes and workspaces may not be able to bill some cases because the properly validated documents are not in the system to permit billing to be completed. Operational managers need to know what the assessment activity is in the facility, both Part A Medicare and other assessments, so that when the activity increases, office staff or clerical support can be present to assist with the tasks and stabilize efficiency. Make the function of this process an operational priority as well as the performance standards for the members of the IDT with responsibility for completing sections of the data set. Completion timelines need to be clearly communicated to the IDT so the data set can be completed and transmitted.
This is a new focus for operations with many specific, important processes. Start now and be on the team to improve compliance with the new process that directs the MDS 3.0 data set completion. This will pay off in many ways for the facility as you provide support to this essential process for fiscal and regulatory success.
Leah Klusch is the founder and Executive Director of the Alliance Training Center, Alliance, Ohio. As an educator and consultant, she has extensive experience in presenting motivating programs for a variety of healthcare professionals. She is a highly sought after speaker and a recognized nurse leader. She can be reached at
firstname.lastname@example.org. Long-Term Living 2010 December;59(12):20-22
Topics: Articles , MDS/RAI , Staffing