MDS 3.0 and RUG-IV: It takes a team

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Loren Claypool
Loren Claypool

As providers prepare for the upcoming implementation, a critical ingredient for success will be having strong leadership team commitment in place. The changes associated with MDS 3.0 and RUG-IV will be dramatic and have high impact on everyone involved. A dedication to new knowledge growth is required and providers must be prepared with their teams of experts who can successfully lead the implementation.  These specialists must be willing and able to develop and clearly impart a vision that entices others to follow with passion and enthusiasm to deliver a successful end result.

Quality, reimbursement changes

It is important to note there are a number of changes that will affect both quality outcomes and reimbursements for providers. Being aware of them will guide preparation for a smooth implementation. The updates that will impact reimbursement after RUG-IV is in place include:  therapy coding; separation of services; scoring; interviews; requirements for assessment and grouping process; and new assessments. The modifications that will impact quality outcomes include: Confusion Assessment Method (CAM); behavior; focus on toileting program; nutrition; balance; and interviews. It is essential that providers are aware of and ready for these changes before they become effective.  The best way to prepare is to have a solid leadership team in place to guide the process.

Leading the way

The ideal leadership team will possess MDS expertise, critical analysis and process skills, teaching/training abilities, project management talent, and the proper technology in place to focus on taking care of residents. A well-defined team with specific job descriptions will serve to prepare providers for the upcoming changes, and encourage a high-performance environment for the frontline caregivers.

The first step is to construct a plan to get the right team in place well in advance of the Oct. 1 start date. In addition to providing a Resident Assessment Instrument (RAI) manual to each member of the interdisciplinary team, the following areas should be considered immediately:

• Training – Provide comprehensive initial and ongoing MDS 3.0 and RUG-IV training for the entire interdisciplinary team and other staff.

• Software – Align software vendors to determine capabilities and how future updates will be handled. A testing and transition plan is recommended well prior to Oct. 1.

• Job descriptions – Delineate clearly defined roles for each specific job description.

• Education and competency – Measure and improve capabilities in wound assessment and management, certification for clinical expertise, interviewing techniques and AANAC certification.

• Staffing needs – Determine staffing levels necessary to complete new Discharge Assessments, which will require one to two hours to complete.

• Clinical assessment and documentation – Scrutinize systems to assure alignment with the following core systems: ADLs; skin; changes in condition; falls; and behaviors.

• Policies and standards – Review policies and standards of practice for correlation with MDS 3.0 for: pain, skin, falls and restraints; restorative nursing; therapy practices; and transmission of assessments.

• Clinical and financial outcomes – Evaluate facility processes and workflow by setting up meetings to allow for thorough interdisciplinary review of resident changes, and ongoing needs for filing and evaluating the best way to maintain the MDS.

• Equipment – Identify and implement equipment necessary for efficient work processes such as hearing enhancement devices, cue cards and adequate computers for data entry.

• Audit process – Build a secure validation process to ensure data accuracy and integrity as well as a continuing plan for process improvement.

Are you really ready?

Reimbursement revenue is at stake and providers cannot afford to wait any longer to plan for MDS 3.0 and RUG-IV. Change can bring resistance, but it is possible to channel that energy into a positive outcome for caregivers and residents. A well-defined and executed plan that includes a highly qualified team of experts will not only enhance clinical and financial success, it will improve resident and staff satisfaction. Full commitment to high expectations in an atmosphere of resident-centered care will trickle down to the staff, affording increased survey outcomes and high quality of life for everyone. 

The author is managing director of VCPI (, a company that helps clients solve business challenges “with technology and beyond.”

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