The CMS launched the re-designed Nursing Home Compare website on July 19th. CMS adopted industry best practices for design and usability while incorporating a significant amount of new information.
Below is a list of new types of information that can be found on the site.
- Quality measures based on MDS 3.0 data. The MDS 3.0 assessments will replace the MDS 2.0-based quality measures previously posted on Nursing Home Compare. In addition, CMS will post data on two measures of use of anti-psychotic medication use (short-stay incidence and long-stay prevalence).
- Detailed Inspection Reports (Form CMS-2567).
- Ownership information. CMS will post information on the legal business names of nursing homes.
- Information on Physical Therapist staffing levels. Physical Therapist hours per resident day will be reported.
One of the most challenging documentation areas in the nursing home setting is Activities of Daily Living or ADL coding. There are many reasons for this; a vast number of staff members contribute to the documentation, the terminology can be confusing, many ADL’s have sub-sets of tasks that impact the coding level and staff members may under estimate how much they assist the patient.
Factors to Consider:
- ADL score is a driver of both the Medicare and Case Mix rates
- Does Staff have a clear understanding of the scoring definitions
- Staff should document resident ADL at the end of their shifts to ensure that they are capturing the correct scores. Resident ADL capabilities change throughout the course of the day
- Do you begin your ADL assessment on day of admission
- Do you consider ADL scoring on a daily basis? Weekly in your UR/PPS meeting
- Do you have a system in place to know when someone is on the border with their ADL score and go back to review the record, interview staff, review therapy notes, etc. to try to find support for the one extra point needed to capture the higher level
- Is there a discussion around ADL scores among the interdisciplinary team to validate general accuracy
- A lot can change within your assessment time frame, so make sure that you are capturing the best ADL score by choosing the best date
A number of factors can have an impact ADL status:
- Acute illnesses
- Exacerbation of chronic illnesses
- Cognitive deficits
- Medication effects
- Behaviors such as resistance with care or agitation
- Lack of motivation
ADL coding is a complex process that involves many staff members & has a significant impact on quality measures & reimbursement. It can be overwhelming if only one or two people are responsible for ensuring the accuracy of the documentation. Accurate ADL coding will result in better Quality Measures, can improve the 5 Star ranking & provides reimbursement for the care that is actually delivered. A comprehensive program utilizing the talents of many people can make your program successful.