On any given day, there are more than 1500 open MDS positions across the United States. With MDS staff feeling the ongoing pressure of staffing shortages, combined with the added stress of the October 1st MDS changes, many facilities are at significant risk of MDS turnover. 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. This week’s blog examines a case example of MDS staffing costs and the benefits of planning ahead for a remote MDS partnership alternative as a supplemental or short-term staffing solution.

1 in 10 facilities are currently dealing with MDS turnover issues. COVID-era burnout, retirement of baby boomers, and existing staffing shortages are causing major strains in all areas of post-acute care. Now with the looming possibility of a staffing mandate, the turnover appears to be on the rise yet again.

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 Provider’s MDS Turnover Story

One recent example is a small midwestern center experiencing repeated MDS turnover. After recruiting aggressively, they hired two very well-meaning, but untrained MDS nurses in the course of a 6-month period. Despite their best efforts, MDS fell behind, and many assessment areas were miscoded. Ultimately, the center lost $30/day in Medicaid reimbursement due to a large drop in Case Mix scores which resulted in a loss of $160,000 for one quarter. They went on to fail their case mix audit which led to further adjustments of the Medicaid rate to the tune of an additional $30,000 impact for the quarter. In addition, the facility received a 2% penalty on Medicare reimbursement for the next fiscal year due to noncompliance with the SNF Quality Reporting Program (QRP). Despite being a smaller Medicare provider, the impact of the penalty yielded an $8000 loss. In short, this provider lost no less than $300,000 in a year due to MDS turnover. Notably, an average MDS salary is currently $60-95k with some approaching $135k in urban areas.

Outside the Box MDS Solutions

it is not uncommon for providers to advertise and recruit for qualified MDS candidates for 6-12 months with no response. As part of the ongoing long-term staffing plan, providers may consider developing a partnership for MDS support to assist during times of crisis, for coverage during vacations/leaves of absence and as back up support to existing staff. In some cases, external support may be part of a short-term plan, while for others, longer-term options may need to be considered. With unstable staffing, MDS nurses may be required to work the floor and be on call which often contributes to the cycle of MDS turnover again and again, ultimately leading to poor Quality Measures (QMs) and reduced reimbursement outcomes. Outsourcing MDS can be part of the staffing solution. Having a designated 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 MDS role is a new way of managing the MDS turnover problem. Onsite MDS support hours are eligible for PBJ, and the assigned MDS consultant can remain a consistent part of your team as needed for as long as necessary—ensuring familiarity with your policies, your residents, and functioning as a member of your team. This solution saves the repeated recruiting and training cost associated with an MDS department in-flux and can often replace the need for additional supervision to ensure MDS accuracy and compliance. With the interim staffing model, you are essentially renting a proven MDS expert to perform this important role efficiently and skillfully with the added benefit of maintaining consistency in reimbursement and quality measure results. The most successful providers are facing the new normal in post-acute care with outside the box solutions and proactive planning to manage risk associated with driving 5 Star Ratings and maintaining reimbursement flow.

Proactive LTC Consulting specializes in MDS Interim staffing and outsourced MDS staff. Proactive has seasoned MDS nurses available to fill in during times of staffing gaps and to train newer nurses to the RAI process. Proactive’s team works with your interdisciplinary team to ensure accurate assessment processes in alignment with the RAI guidelines through onsite, fully remote or hybrid-remote MDS support partnerships. Procedures are customized to align with facility processes and Proactive’s designated expert(s) work with the facility nursing team to ensure all MDS assessments are reflective of the resident and their plan of care. The remote and/or hybrid-remote process can work quite well and, with the added efficiency Proactive brings, can save costs, all while gaining access to Proactive’s team of experts to ensure effective coding for payment accuracy and compliance. Contact us to learn more.


Rosanna Benbow, RN, CCM, ICC, IP, DNS-CT, QCP, RAC-CTA
Regional Director

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