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had the privilege of being involved in the training and development of the first Minimum Data Set (MDS) in South Carolina. In 1990, many long-term care facilities throughout the nation were skeptical about the required assessment. I attended many conferences introducing the MDS and several training sessions sponsored by the Centers for Medicare and Medicaid Services (CMS, known at that time as the Health Care Financing Administration or HCFA) and other professional organizations.
       I heard many complaints and concerns from administrators and directors of nursing (DONs) regarding the MDS. Many felt the requirement was merely a financial burden on the facilities, nothing more than “paper compliance.” The focus was too often on “how to meet the requirement,” rather than how the new process would improve assessment and care of the long-term care resident. Since those early years of its implementation, however, the MDS has proven to have much more impact on facility processes than providers imagined. Some of these processes include but are not limited to resident care outcomes, survey processes, quality improvement activities, and financial and legal outcomes.
       By 2005, the MDS has undergone revisions and updates. New Day Professional Services consults and educates providers on completing the MDS and Resident Assessment Protocols (RAPs) at least bimonthly, and New Day consultants are constantly amazed by the number of facilities and/or MDS coordinators unaware of the updates or clarifications that are posted on the CMS website.
       Staff of New Day recently consulted at a facility that was still using the 1995 version of the Resident Assessment Instrument (RAI) manual, rather than the revised manual published in December 2002. The revised edition contains many clarifications of the 1995 version, although the MDS instrument itself did not change. When consulting on-site, I often ask to see the RAI manual and discover that facilities are not aware of the updates on the CMS website, which become effective the day they are posted. Since the 2002 revised manual was published, there have been 3 updates posted on the website—1 in August 2003, 1 in April 2004, and 1 in June 2004. Facilities can visit the following website to obtain the updates: http://www.cms.hhs.gov/medicaid/mds20/default.asp.
       Recently, I started a “MDS Support Group” for MDS Coordinators in South Carolina. The group meets at least quarterly to discuss any updates, requested topics, and clarifications. This type of group activity gives participants an opportunity to network, discuss issues they are having with the MDS process, and suggest upcoming discussion topics. The group discusses topics, such as documentation, Prospective Payment System (PPS) issues, methods of information gathering, etc. A key discussion item is how to involve staff nurses and encourage them to provide meaningful documentation during the MDS assessment period.
       One of the items presented at a past meeting was a tool for quality assurance review that could be utilized by staff nurses to validate (or not validate) the MDS responses. Prior to introducing the tool, I suggested the MDS coordinators teach staff nurses the definition of Assessment Reference Date (ARD) and what information they need to document during that assessment period, in addition to their regularly scheduled charting processes. Meetings like the MDS support group can be held for small fees, but the return on the investment can be great.
       Since all updates are now posted on the CMS website and effective the day they are posted, it is most important that facilities have a method of getting this information to MDS team members. Many facilities do not allow staff members to have access to the Internet from the facility location; in this case, the MDS staff member may not be aware of updates if he or she does not have access to the Internet at home.
       In addition to the updates posted on the website, MDS team members would benefit greatly by attending updated MDS training. In fact, many progressive facilities send their MDS coordinators to MDS training at least once a year. The MDS process is fully explained in the RAI manual, but it is always helpful to receive validation that you are completing the process accurately and timely. That is not the case in many facilities, even when the MDS coordinator has had the position for years.
       To ensure your facility is where it needs to be in the MDS process, consider providing the following:
• Initial, extensive MDS training
• Updated training/review at least once a year
• Access to the Internet for CMS updates or access to someone who can print and provide the updates for the MDS team members
• Copies of the most current RAI manual for all team members
• Training and understanding of PPS/MDS process for all team members, including therapists
• Quality assurance activities that validate MDS accuracy and timeliness
• Basic MDS training for staff nurses
• Process through which all nursing staff, including nursing assistants, understand the ARD and how they can contribute information for it
• A back-up or alternate staff member to coordinate or complete the RAI process in the absence of the current MDS coordinator
• Encouragement for MDS team members to participate in local meetings designed specifically for them.
       The industry has experienced many changes in the MDS process not mentioned in this article, such as the Data Assessment Verification Project (DAVE). There has also been a push for MDS coordinator certification or credentialing. While this is a positive learning experience and acknowledgement of competency for the MDS coordinator, keep in mind that the MDS process is and will continue to be an evolving process. To remain up to date, facilities will need to take measures to ensure that their staff remains updated—not only to meet regulations, but also to benefit the residents and care processes.

For more information

To purchase an updated MDS manual that contains all updates up to the date of purchase, please contact New Day Professional Services at 803-796-7835.