The COVID-19 Public Health Emergency brought with it many changes and challenges for long-term care facilities. In many cases, staffing became critically low due to employees leaving permanently or temporarily because of intermittent illnesses and quarantines. Facilities fortunate enough to maintain MDS staff often relied on them to fill open positions on the floor in efforts to continue to provide quality care to their residents, and while the decision was necessary and appropriate, this left required MDS assessments to be completed late, inaccurately, or not at all. And then the idea of remote MDS completion entered the chat…
The idea of completing MDS assessments remotely, or off-site, was not a new concept but was not a regularly accepted work practice for many providers. It has long been expected that the MDS nurse(s) be fully onsite and directly assessing residents to produce the most accurate MDS assessment possible, but is that the only effective way? Proponents for remote MDS completion tout the likelihood of assessments having higher accuracy as the remote MDS nurse is allowed to focus solely on the assessment and supporting documentation and have fewer interruptions that may lead to errors. CMS has stated that there will be more to come on this topic as they will need to address what they expect must be done onsite versus offsite, but acknowledge that every industry is now having to consider how to accommodate what’s possible for remote work. Let’s take a closer look at what it takes to make a remote MDS completion process more successful.
How do you ensure assessment accuracy from afar?
Maximize EHR accuracy and secure accessibility – For anyone working remotely, most, if not all of the medical record must be readily available for review. Consider the capabilities of the current software and what may or may not be integrated. For example, are therapy notes integrated or uploaded elsewhere? Where are records from outside providers kept? A HIPAA secure shared drive may be a viable option for facilities that still rely on paper documents.
Collaborate and clarify – Remote MDS does not simply translate to “data entry clerk”. The MDS nurse should still effectively communicate with the IDT and seek clarification if documentation seems lacking or contradictory. The trained MDS nurse is also uniquely positioned to identify areas of potential opportunity and needed improvement. For example, remote MDS may be responsible for ensuring Section GG assessments are completed timely, or querying the physician for diagnoses that may impact PDPM reimbursement. The remote MDS nurse is reviewing the entire record with an eye toward clinical quality and reimbursement accuracy, and should be expected to not only code the MDS accurately, but also share findings and opportunities with the rest of the team.
Partner with an onsite nurse – Remote MDS completion doesn’t come without its own challenges, the obvious being a lack of hands-on, eyes-on assessment. Because of this, it’s important to have a clinical liaison to further the processes of collaboration and clarification when needs arise. The data entered remotely into the MDS is only as good as the clinical information gathered onsite in areas such as skin assessments, usual functional performance, and resident interviews for pain, mood, and mental status. These elements, among others, need to be adequately documented in the allowable timeframes for appropriate reporting on the MDS. Video conferencing with the resident and/or representative may also be facilitated and lend a hand to the process in certain instances as appropriate. As with many items throughout the MDS, the mood and mental status interviews can have a direct impact on reimbursement, and positive gains can be lost if the interviews are not conducted, or conducted after the Assessment Reference Date.
How do you address changes or identified concerns?
Participate in meetings – Working remotely does not mean working in isolation. Technology has made it easier than ever to remain involved in scheduled meetings and important discussions, and remote participation should continue to the extent practicable. This includes virtual participation in the daily clinical or stand-up meetings, Medicare or utilization review meetings, and triple-check or month-end meetings as assigned. As these are generally scheduled and structured gatherings, they are perfect times to exchange valuable information and address changes or concerns in real-time. These are also built-in opportunities to review suspected changes in resident conditions and relay the upcoming MDS assessment schedule to ensure all evaluations and documentation elements are in place to maximize information gathering and data accuracy.
Communicate with the IDT – As things will inevitably arise in between meetings, it is also important to communicate directly with applicable IDT members. Make sure that organizational charts, email addresses, acceptable methods of communication, and schedules of availability are current and maintained.
Staffing support – As long as the lines of communication remain open, remote MDS completion can be a lifesaver for facilities struggling to fill the MDS role, and has proven to be a cost-effective option for many facilities given the risk of lost revenue associated with missed, late and/or inaccurate assessments. In addition, in many cases, the efficiency of remote MDS completion presents further savings. Even a hybrid schedule of onsite and offsite days has become of interest to some looking to apply for the position. Remote MDS programs can offer a solution to short or long-term staffing gaps while simultaneously allowing the MDS nurse to focus on the MDS role and the clinical and financial benefits of an accurate assessment.
MDS struggles? Proactive can help. Contact us to learn more about interim remote MDS services, consultation in developing a remote MDS program in your facility, or orientation and training of staff new to MDS.