Rosanna L. Benbow

Today, if you search for MDS jobs nationwide you will find a staggering number of open positions. On any given day you can find more than 1,200 to 1,400 open positions across the United States. 

That’s just under 10% of all skilled nursing facilities that are experiencing MDS turnover — and in some areas, it is a far greater percentage. COVID burnout, combined with the baby boomers retiring and otherwise massive staffing shortages are causing major strains in all areas of post-acute care. 

The dangers of MDS turnover can be catastrophic for providers.

With the Patient Driven Payment Model, case mix reimbursement and Quality Measures all tied to the accuracy of MDS assessments, turnover can cost thousands of dollars outside of the recruitment and training itself. 

One example we’ve seen this year is a small center with MDS turnover in late 2020. It has had two very well-meaning, untrained MDS nurses in a six-month period. MDS fell behind, and many areas were miscoded. The center lost $30 per day in Medicaid reimbursement due to a large drop in case-mix scores. That was $160,000 for one quarter. They failed their case-mix audit, which resulted in further adjustments of their Medicaid rate. An additional $30,000 impact for the quarter affected. 

They received a 2% penalty on Medicare reimbursement for the next fiscal year due to noncompliance with the SNF Quality Reporting Program (QRP). As luck would have it, they are a smaller Medicare provider, but this is still an $8,000 impact. In short, with no intervention, this provider is losing no less than $300,000 in a year due to MDS turnover. An average MDS salary is currently $60,000  to $95,000, with some approaching $135k in urban areas. 

Maureen McCarthy

We have seen providers try advertisements and recruiting for six to 12 months with no response to find qualified candidates for MDS. To address this, some companies offer both short-term solutions including interim MDS staffing and outsourcing MDS staff, as well as having seasoned nurses fill in and train newer nurses to the RAI process. These companies are run by long-term reimbursement consultants, and they have streamlined the process of transition to a fine art. 

The preference is always to work onsite with the interdisciplinary team to have accurate assessment processes in alignment with the RAI guidelines, but they have also found ways to work remotely when needed, partnering the provider with their nurses to ensure all the MDS assessments are reflective of the resident and their plan of care. 

While this is meant to be a short-term plan, some providers may need to have a longer-term option. With the staffing turnover, and some MDS nurses working the floor and being on call, the cycle continues and MDS turnover happened over and over again causing the providers to continue to have poor Quality Measures (QMs), and poor reimbursement outcomes. 

Outsourcing MDS nurses can be a solution. Having a contract nurse that specializes in MDS and works directly with your team but cannot be pulled into the daily issues that distract from the importance of the role is a novel idea. You still can use their hours for payroll-based journaling, as with any other agency staff, and they remain a consistent part of your team. They are familiar with your policies and your residents, and function as team members. 

This solution saves the constant training cost and can even in some instances replace the need for additional supervision to ensure MDS accuracy and compliance. You are renting consultants to perform this important role for you and maintain consistency in your reimbursement and quality measures. 

Whatever the case, providers are already in dangerous waters as we return to a new normal in post-acute care, and we need to be open-minded about solutions to keep the reimbursement flowing! 

Rosanna L Benbow, RN, CCM, ICC, IP, DNS-CT, RAC-CT is the owner and lead MDS consultant for Leading Transitions Post Acute Care Consultation and Staffing, LLC, which provides MDS consulting and Interim MDS services. She has more than 24 years’ experience in post-acute care in roles such as MDS Coordinator, Director of Clinical Reimbursement, Director of Nursing Services and MDS consultant.

Maureen McCarthy, BS, RN, RAC-MT, QCP-MT, DNS-MT, RAC-MTA is the CEO of both MDSRescue and Celtic Consulting. MDSRescue provides MDS completion services to nursing homes across the country. She has more than 35 years of skilled nursing management experience including MDS Coordinator, Director of Nursing, Rehab Manager and Medicare Biller. 

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.