Navigating MDS changes with Jenny Lee, Regulatory Compliance Manager, and Cassie Diner, BSN, RN, CPHIMS, CSPO, SA, Clinical Product Manager

Episode 62 April 21, 2023 00:39:10
Navigating MDS changes with Jenny Lee, Regulatory Compliance Manager, and Cassie Diner, BSN, RN, CPHIMS, CSPO, SA, Clinical Product Manager
The Post-Acute POV
Navigating MDS changes with Jenny Lee, Regulatory Compliance Manager, and Cassie Diner, BSN, RN, CPHIMS, CSPO, SA, Clinical Product Manager

Apr 21 2023 | 00:39:10

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Show Notes

In this episode of the Post-Acute POV, originally featured in the McKnight’s Long-Term Care Expo, Jenny Lee, Regulatory Compliance Manager, and Cassie Diner, BSN, RN, CPHIMS, CSPO, SA, Clinical Product Manager, have a conversation on the major changes coming to MDS and how skilled nursing facilities can prepare.

Join Jenny and Cassie as they discuss how the new MDS items may affect your assessment process moving forward, what you should do to help your staff prepare for these changes, and what to look for to ensure your technology vendor is working to ease this transition. Listen to their discussion below.

Topics discussed during today’s episode:

  1. [01:47 – 07:09]: Cassie greets the audience, introduces the topic, and provides background on her expertise in managing regulatory changes. She then offers seven recommendations for providers as they prepare for the MDS changes going into effect, on October 1, 2023.
  2. [07:09 – 12:13]: Next, Cassie elaborates on the main changes: Section G or functional status being removed from standard OBRA forms, the potential for new OSA or state forms, 29 new or modified MDS questions bringing more commonality between post-acute care and the OASIS form used in home health, and more.
  3. [12:13 – 18:06]: Cassie describes both a complicated and simple reimbursement change that was made at the state level. Wisconsin’s elaborate PDPM transition and Illinois’ much simpler transition to PDPM. She goes on to discuss the state-level uncertainty and nuance with the OSAs.
  4. [18:06 – 22:58]: Cassie and Jenny share what the audience can do now to prepare. Review your assessments or observations completed by nursing and other parts of the interdisciplinary team within your EHR system to see where changes need to be made and eliminate questions or change questions prior to the October 1st deadline to capture necessary data.
  5. [22:58 – 28:29]: Next, Cassie describes how organizations should work with their technology vendor as we approach these major changes. Attend your vendor’s advisory council meetings and share your status or any new information to stay on the same page with your vendor. Also, consider participating in complimentary training provided by CMS.
  6. [28:29 – 33:47]: Cassie describes the three roles that facilities should focus on as CMS begins to release the requisite documentation: caregiver or nursing staff, dedicated educators, and MDS coordinators. She then shares some key insights and feedback she has gathered within the industry.
  7. [33:47 – 38:15]: Cassie closes the discussion by sharing how the coming months will be huge for continued success leading to October as the CMS is expected to release final MDS questions and item sets. It will remain a top priority to stay in the loop with your technology vendor.

Resources

Disclaimer

The content in this presentation or materials is for informational purposes only and is provided “as-is.” Information and views expressed herein, may change without notice. We encourage you to seek as appropriate, regulatory and legal advice on any of the matters covered in this presentation or materials.

©2023 by MatrixCare

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Episode Transcript

Speaker 1 (00:01): Hi, and welcome to the post-acute point of view, our discussion hub for healthcare technology in the out-of-hospital space. Here we talk about the latest news and views on trends and innovation that can impact the way post-acute care providers work, and we take a look at how technology can make a difference in today's changing healthcare landscape, in both home-based and facility-based care organizations, and the lives of the people they serve. Let's dive in. Speaker 2 (00:32): I'm McKnight Senior living editor Lois Bowers, and I'll be the moderator of this session entitled Major Changes Coming to MDS. What [inaudible 00:00:40] Need to Know to Prepare. The latest MD's Patient Assessment Tool released by the Centers for Medicare and Medicaid Services could affect your reimbursement formula and your assessment process. In this session, you're going to get actionable steps to help your staff and your facility get ready for the big changes. And now I'd like to introduce today's speakers, Cassie Diner and Jenny Lee. Cassie Diner is clinical product manager at Matrix Care. (01:06): She joined the clinical team in May 2013 after graduating from college with a BSNRN. That same year she became the RN charge nurse at a long-term care facility, a position in which she continues to work. In 2015, she became a senior trainer and in 2018 became a senior manager of client education at Matrix Care. Jenny Lee is a healthcare regulatory expert with more than 15 years of experience. At Matrix Care, she's a regulatory compliance manager helping to ensure that all of the company's technology solutions remain compliant in the ever-changing healthcare market. So without further ado, I'm going to turn things over to Cassie Diner and Jenny Lee. Cassie Diner (01:47): Good day to everyone and thank you so much for joining us today. We know how hard all of you work day in and day out, and we are here to provide a large amount of information condensed into less than one hour session, with takeaways designed to help educate you and give suggested actions you can take now around planning for upcoming regulatory changes. I've worked closely with providers, caregivers, industry experts, and regulators to consolidate information for what's needed to prepare for October 1st 2023. In today's session, you will learn what the elimination of Section G means, and more specifically, what it means for your reimbursement formula, how the changes will impact current processes around assessments and what you can do now and in the future to educate and train staff, what some state ambiguities are and how to prepare and navigate these based on learnings from other states, how to collaborate with your EHR solution vendor. (02:44): Now with my clinical expertise, I'm going to give you a high level overview of what providers should be doing to prepare for October. Now, I took some time to utilize an open AI source to see what exactly is available out there as far as valuable information, and then I compared it to our list for fun. I'm not sure if any of you here have used ChatGPT quite yet, but basically I love it, and it's the latest hottest craze. If you haven't experimented yet, let me just share you, it's not only available for everyone for free, but you basically can ask it anything. For example, you can ask it to create a resident specific care plan for an 85-year-old female with diabetes, let's say, high fall risk, et cetera. After you enter, it'll either reply with a follow-up question or display results in a matter of seconds. (03:35): So I thought it would be great to find out what the chat bot had to say about preparing for the MDS changes for this October 1st. Basically, the results were pretty spot on, so I asked ChatGPT what step skilled nursing facilities should take to prepare for the MDS regulatory changes that are said to go into effect this October 1st, and within seconds here were the results presented in a list of seven recommendations. First review and understand the changes. Yes, in today's session we will cover this in more detail on how skilled nursing facilities should review and understand the changes to the MBS regulatory requirement at both the federal and state level, and also utilize tools to ensure all staff are aware. This includes reviewing an updated RAI or resident assessment instrument, users manual and any other guidance provided by the Centers for Medicare and Medicaid Services, CMS. Update your policies and procedures to reflect the changes to the MDS regulatory requirements, provide staff training, specifically on the new MDS regulatory requirements and how your policies and procedures are impacted. (04:48): This includes providing training on the updated RAI users manual, changes to the MDS assessment, process and new documentation requirements. And as part of this process, and with continued labor challenges, you should also be identifying staff competencies. And then number four, conduct internal audits. Now there are multiple forms of audits to be completed, and since we're on number four, here are four quick examples of recommendations for internal audits. Number one, conducting internal audits to ensure that the need for care assessments and content are accurate, and that these include content that clearly identifies the need for skilled care and supportive approaches. Reviewing and auditing your pre-admission screening to ensure you are documenting as much information as possible within the resident record. Auditing if you are using the best interview tools to gain better insights from families and caregivers in addition to the resident. And number four, plan to complete some pilot studies with a small controlled group on new processes. (05:54): Establish specifics on what that measure, what you want to measure, for how long and what you're going to do with those results. If you still need to standardize processes, make sure you continue to audit and make adjustments along the way. Now back to our overall list for preparation. Ensure accurate coding. This includes ensuring that your MDS assessments are accurately coded to reflect the resident's current medical and functional status. Coding may also ensure staff are accurately coding correct ICD10 codes and providers in providing the correct information needed to code accurately. And number six, monitor and track outcomes related to the MDS assessments to ensure that they are meeting regulatory requirements, and that high quality care is provided. You can do this by utilizing reporting, analytics and dashboards, and this is really tied back into auditing and ensuring standardization is a current process, because this is needed for quality and valid results. Overall, standardization is required to compare outcomes across facilities. And number seven, seek assistance when needed. This may be from outside resources such as professional associations or consultants if you need additional support in preparing for the MDS regulatory changes. Jenny Lee (07:09): Thank you, Cassie, for this example of how AI can be used to query for information these days. I agree, ChatGPT is spot on, and those seven recommendations make a lot of sense along with your explanations. I really liked how you expanded on the basic seven. The points you made on auditing, specifically, are incredibly valid and a great takeaway for providers and immediate planning. So make those lists so you can check them twice. Auditing care assessments, documentation, pre-admission screening, conducting effective interviews with residents, their family and caregivers, and doing pilot studies. I'm also thinking now of the need to monitor and track outcomes, and how important analytics, dashboards and reporting are around this. Just the time savings of using an analytic solution that automatically presents data in the form of charts and trending graphs, to monitor for outcomes, is becoming increasingly significant to success. Cassie, now that we've had a preview of what to do to prepare, with your background and expertise in long-term care, could you lead us through the major changes that are coming effective October one? Cassie Diner (08:19): Absolutely. So really the first topic, and what everyone's been anticipating for years now, is that Section G or functional status will no longer exist within the standard OBRA forms. Therefore, facilities will not be able to formulate a resource utilization group or RUG score, which shows the type and quantity of care required for each individual resident. Now this is a major change for the industry, and we are thrilled that all of you have joined us today to really start and prepare and hear more about this. To add an additional twist, and I'm not just talking vanilla and chocolate here, it is critical to remember there may still be a new OSA or state forms, also known as optional state forms or assessments, which may continue to require section G and could add to even more work. (09:08): Now, I love to travel, so I was thinking of a way to creatively tie MDS changes to that. Well, in the airport you hear about the 3-1-1 liquids rule, right? Three ounces, one quart bag, and one person. I then tied this into MDS changes and you get that incredibly simple 29-17-13 rule based on the current information we have. Okay, not so simple, but the complexity of CMS changes and especially those coming this October are what we all thrive on. Jenny Lee (09:43): I couldn't agree more with the complexity, 29-17-13, there's no pattern there. This is anything but simple. So can you explain what we know is changing and tell us a little more about what these numbers mean. Cassie Diner (09:56): Of course. So this rule is from three main questions to ask yourselves when it comes to outlining the changes. Did you know that there will be 29 new and modified MDS questions? And really the bottom line of these questions to take note of, are that these questions are bringing more commonality between post-acute care and the OASIS form used in home health. Now the second question, did you know that there'll be 17 care area assessments, or CAA worksheets, impacted with these changes? And did you know that there'll be 13 CAA triggers updated? You can all now use this fun tip when training your staff, remembering 29-17-13. New and modified questions, CAA worksheets impacted, CAA triggers updated. Jenny Lee (10:44): Thanks for sharing that valuable insight and fun tip while explaining the number of changes in the various area of MDS and CAAs. Your first point that we've all been anticipating, the removal of section G and the inability to calculate a valid RUG score. Can you explain a little bit more about what that means? Cassie Diner (11:04): Of course. The RUG's payment model really incentivized the volume of therapy minutes provided, patient driven payment model or PDPM, was intended to more appropriately reimburse providers for treating the residents specific needs holistically. Understanding this change on care and billing processes is the key to a successful change to PDPM. For example, the reimbursement of care for clinically complex residents is much more attractive. With the impact reimbursement formulas, facilities will want to document and review all processes related to MDS management and reimbursement. Since identifying the correct payer drives the assessment schedule, item set and completion dates, ensuring you identify and enter the correct payer in a timely manner continues to be important. This is because missed assessments or timing can be costly. Now, I know that this isn't necessarily something new for some or most of you, but I wanted to ensure you continue to understand the importance. Overall, when it comes to reimbursement, the triple check will continue to be extremely important as well. Jenny Lee (12:13): So Cassie, thank you for tying that information together. Now speaking of reimbursement, I know with your experience you have seen a few different versions of how states are making the transition to PDPM. Can you touch on a complicated change a state made, and then a more straightforward example to illustrate some of the differences for our audience today? Cassie Diner (12:33): Great question, Jenny. So let's start with a more complicated state, and take Wisconsin's story where they are famous for their cheese and complicated PDPM transition. Wisconsin's approach was to model reimbursement after Medicare, modifying the methodology to exclude the therapy components of the HIP score from the rate calculations. This approach requires accommodating resident specific rate calculations to align with the state's reimbursement. Now on the other hand, we have Illinois' story, where they're famous for the windy city of Chicago being the third-largest city in the United States and an easier transition to PDPM. Illinois, and really other states for that matter, have chosen to incorporate PDPM methodology into their calculations to generate a facility reimbursement rate rather than being reimbursed on individual resident assessments. (13:25): In this case, the PDPM component and other facility specific data is used to create a weighted case mix for each facility. This is then applied to an established statewide base rate. It is important to keep in mind that most states are still in the planning stages and are holding regular town meetings to keep state holders informed. It is critical that providers and EHR vendors closely monitor each state they operate in to ensure they'll be compliant when the PDPM transition takes effect. Jenny Lee (13:55): Great point on that. We have seen several states transition to PDPM, some in a much more complicated way than others. I wish I had a crystal ball to see a clear line of sight to all 50 states plus DC and October 1st. Just the reimbursement rules, at the federal level, are going to be enough to digest and implement. So my hope is states will keep things as simple as possible. That being said, we haven't even mentioned the impact on complexity other payer types will have, such as managed Medicare and managed Medicaid. These payer types are bound to have changes to documentation, billing and audit requirements. (14:33): It's critical for providers and EHR vendors to closely monitor those as well. However, sometimes I relate back to, it's better to be prepared for the worst and hope for the best. With all these changes, I want to take us back to something you had keyed in on earlier, state level ambiguity. Cassie, you shared federal changes regarding removal of section G from OBRA assessments and gave examples of states that have already implemented PDPM, and you briefly mentioned the state OSSA, or optional state assessment, and how some states may still require section G. Can you discuss further the state level uncertainty and the nuance with the OSAs? Cassie Diner (15:17): Great questions. So there continues to be a lot of uncertainty around the OSAs. CMS released specifications for OBRA assessments on February 14th, Valentine's Day in fact, which love was definitely in the air and included a very important note. It is important to keep in mind these are the rules that drive the MDS validation process, and things are still up in the air on how to handle these. Bottom line, we are all still waiting on confirmation about how OSAs will be handled by CMS. For example, how will CMS handle section G on an OSA assessment which could lead to extra assessments and extra documentation required. Also, we are all still waiting on which specific states want to continue utilizing RUGs. Jenny Lee (16:02): So it sounds like providers in undecided states should consult with their State Department of Health and other state level regulatory agencies for guidance as they continue through this process. Now, Cassie, can you give us some additional insight into what these changes mean for different states? Cassie Diner (16:18): Sure thing, Jenny. But first, since this information can be considered pretty dry and detailed, let me share a ChatGPT MDS joke, if I may. Why did the nursing home administrator feel like a travel agent when trying to keep up with the state specific MDS changes? Well, it's because they were always worried about the latest state of affairs. All right, now let's get back to looking at the timeline of state changes. So first, in 2019, Medicare stopped using RUGs and began to use the new patient driven payment model. At that time, no states adopted PDPM because there was no clear path from CMS on how to really adopt this. (16:58): In fact, it took three years for Wisconsin to even begin using it. With the end of the RUG calculation on the standard OBRA forms, what does this mean for a case mix states? Well, these states could be forced to change the reimbursement model as current state calculations are spread across a variety of old RUG groupers, which at times reminds me of beginning of a football play, 34-44-53 down set high. Overall, some states use the default CMI values for their selected grouper while other states define their own CMIs. Jenny Lee (17:33): You mentioned previously that state decisions to continue RUGs may require more work. Can you explain what that means? Cassie Diner (17:40): Well, bottom line, if your state wants to continue utilizing RUGs, then an extra OSA form could be required in parallel with the OBRA assessments. Meaning upon every admission, an admission assessment plus OSA form would be required. This would result in extra work overall. This represents a large effort by states. Those who complete MDS assessments will need to adjust for October changes. Jenny Lee (18:06): Now, before we dive into what to do between now and October 1st, I don't have a good MDS joke, but I wanted to share an MDS poem with everyone. MDS, oh, what a pain, regulations changing once again. It's like a game of whack-a-mole, trying to keep up takes a toll, we'll tackle each change with a grin and make compliance a win-win. We'll dance our way through every code and make it seem like a silly ode. So let's embrace this challenge anew and laugh at the absurdities too. For we're in this together, come what may and we'll get through each MDS day by day. Cassie Diner (18:45): Thanks, Jenny. That was fun to hear and I bet you used ChatGPT, unless you're a poet and you didn't even know it. Now back to discussing how we were in this together. Let's get back to what our audience can do now as we anticipate what the future will bring. Let's take a look at steps to take now during a very crucial time. You want to review your assessments or observations completed by nursing and other parts of the interdisciplinary team within your EHR system. You want to see where changes need to be made. You may want to eliminate questions or change questions prior to the October 1st deadline in order to capture needed data. We know ADL documentation related to Section G is being retired. The draft forms indicate that section GG functional abilities will be active on admission, quarterly, annual and significant change OBRA forms. (19:40): Some questions you may want to ask yourselves are, what processes are needed to capture functional ability data for OBRA? Can the functional ability processes used for PPS replicated for OBRA? You will also want to consider that some of the processes you have in place will become obsolete because of these MDS changes. For example, question O0100, which is being retired, collected information on special treatments and procedures such as oxygen therapy. It is being replaced by O0110, which also captures special treatments and procedures. The difference for O0110 is that when oxygen therapy is selected, you can also answer if it was continuous, intermittent, or high concentration. It is important to note that the RAI manual is still required to understand what some of the new questions even mean. For example, a question like N0415, which includes a follow-up question asking if indication is noted, and is unclear on what that even means exactly at this time. (20:48): The updated mood interview is now PHQ two to nine, which includes skip logic based on responses to the first two questions. And furthermore, it's important to understand that since MDS questions tied into measures, there may be a direct impact to quality measures and quality reporting. CAA worksheets will also be impacted. For example, CAA-5, or activities of daily living, ADLs, is effectively disabled by its dependency on section G. CAA triggers, defined by CMS, and identified in Section V when triggered, include questions from many sections. For example, section G in addition to CAA-5 factors into CAA-6 and 16. Jenny Lee (21:34): Cassie, your detailed understanding of these changes, and steps to take now, is really incredible. Going back to your beginning seven points, and tying these in, I can't help but to refer back to overall planning and making lists. The key things being to understand the changes, review assessments and make changes, inform and educate your staff, put your implementation plan in place with audits and measuring, and dedicate staff to assist with education. Now I'll turn it back to you, Cassie. As we think of steps to take that involve people from outside the walls of a skilled nursing facility and beyond facility staff. Let's talk more about how the vendor customer relationship can continue to be enhanced with these changes. Cassie Diner (22:21): Definitely, and there continues to be steps you can take now to follow along with changes and new details as they are released. You'll want to get familiar with your vendor's website and resources, including client communities, educational tools and recordings, newsletters, updated documents, blogs and more. You should attend webinars when available and attend advisory boards for asking questions and sharing information. Also, vendors should be proactive at both the federal and state level, and seeking updated information to share with their customer base. Jenny Lee (22:58): Now, Cassie, when you mentioned attending vendor advisory councils or boards, and the importance for others to share information and keep their vendors updated, can you explain how our audience can do that? Cassie Diner (23:11): Yes, great question. Absolutely, Jenny. You said it best from your poem, actually. We're in this together. Sometimes documentation is received from states that vendors don't always have access to, or special conferences and webinars are held. Any state specific information is critical to October 1st success. Please communicate any information you have related specifically to states as you receive it. Just as we initially crossed the bridge to PDPM, from a federal perspective, there continue to be a lot of details that the states are working through, and together we can bring clarity to the details. Also following October 1st that the MDSs are production, accepted and claims are submitted without rejections. Now back to my airport analogy of 3-1-1, and the long-term care complicated, 29-17-13. 29, new and modified MDS questions, 17 CAA worksheets impacted and 13 CAA triggers updated. Here's another airport one for you from the travel lover in me. (24:19): When you see or hear something, say something. If your state puts out new information, as we move forward here through 2023, let your vendors know. Let your networks know. And let's work together to make the major transition go as smoothly as possible. I assure you, as details are released, your vendors are continuing to ask the hard questions for more details from CMS and states. Questions that bring clarity to the most complicated what if scenarios. Now I'll bring you two examples of what if scenarios that will make anyone twist beyond vanilla and chocolate. First one, the resonant admission around the end of September. Be thinking about, as your technology vendors are, planning for those residents that are admitted around September 29th. These residents will immediately be crossing over from September to October dates of service. Second question, the residents who are in-house, September 30th through October 1st, remember, look backs for assessments start before October 1st since the ARDs need to be between October 1st and seven. All residents in the home on September 30th and October 1st will need an assessment. Jenny Lee (25:35): With all these transitions. Do you think some people will be doing early quarterly assessments? Cassie Diner (25:40): You know, that's a great question, because we have seen that in the past, but again, it all depends on how individual states will handle this based on usage of RUGs or PDPM. For example, will states continue the use of current CMI but require an OSSA, or will the states require an OBRA assessment to be done? Everyone is kind of in the waiting game, but in it together. Now on the next slide, I have listed specific complimentary trainings provided by CMS that will be available and specific months as of now. So MDS 3.0 training will be in two parts, focusing on the new MDS questions, and you may want to highlight these on your calendar now. May will include the release of recorded videos, and then late June, early July, we'll include live virtual workshop sessions, which will be recorded for on demand viewing. And registration will be open and announced later this spring. Again, mark this on your calendar now. Jenny Lee (26:40): Thank you for that information, Cassie. So we have the steps to take now with those within and outside your organization and upcoming CMS trainings, but we know we are waiting on some critical details with all of this. Going back to your scenarios and thinking about assessments and details, as we transition from September to October this year, what are some of the other important dates to pay attention to, folks to expect more detailed information? Cassie Diner (27:09): Well, first of all, it's important to point out that some items are still in draft mode and your EHR vendor should be paying special close attention. Now, I must point out the first date of April 1st, it's no joke. However, the date is most likely going to change due to April 1st actually falling on a Saturday this year. Next up, you can anticipate seeing OSA information in item sets along with specifications by late April, early May. Then sometime within May, the final MDS specifications. And lastly, but certainly not least, the final RAI manual in August, with a little window of time before the October 1st changes. Jenny Lee (27:54): So we can see that information is limited at this point, which includes the draft of MDS forms that could change before they're finalized. And currently there is no RAI manual that has been released. Also, we only have the draft specifications which define when MDS questions are active or inactive, and when these questions might be skipped. However, even under these conditions, the draft MDS forms do provide some direction and ability for vendors to work with customers. Cassie Diner (28:23): That's right, Jenny, and have no fear because it's Jenny and I who have further information right here. Jenny Lee (28:29): That's right. And for our large audience today, just remember we are all in this together. Cassie, keeping these dates in mind, and that they are coming up quickly with just a little over six months until October one, can you give us your expertise on what three key roles facilities should focus on first and foremost as CMS begins to release the requisite documentation? Cassie Diner (28:52): Absolutely. So here we'll focus on three important key roles critical to this transition. The first role is the caregiver or nursing staff. Staff confidence is always key to success, especially around change. You'll want to determine staff learning needs to be PDPM competent. When doing this, it is important to identify staff competencies needed to care for the changing population. Set a plan in place for your caregivers to feel confident with the changes coming. Also identify those most appropriate to answer GG questions. The second critical role is the dedicated educator role. Assist and guide your educators to create a training outline and plan ahead of time. Mandate training and include not only what the changes are, but also the reasoning. (29:45): For those of you operating multiple facilities, oversee influence the consistency in training. And finally, ensure your training is targeted by roles. Educate role by role so that your staff can learn as efficiently as possible and focus on what impacts them with the changes. This also will help the changes be more digestible. And the third significant role, and which leads to overall success, is the MDS coordinator. Work as a team and lean on your MDS coordinator to influence and identify which forms, observations or assessments, need to be updated based on the new regulations. Also specify and further analyze changes, such as identifying roles and responsibilities for your full interdisciplinary team, and all of those that contribute to the MDS and new knowledge requirements is critical for success. To start small on this, I would work through your MDS coordinator and alert stat that the draft forms are available today. Allow your MDS coordinator time to become familiar with the draft forms. If possible, encourage those who work at the MDS to review these forms so they can identify the impact on their current processes. This will ultimately smooth the transition. Jenny Lee (31:02): Thank you, Cassie. Now from things to prepare, an overview of changes highlighted by section G going away, explaining more about state ambiguities, things to do within your organization and outside your organization, listing important trainings and dates when we expect new details, and identifying these key roles and facilities to focus on as we approach October. I know you work closely with industry leaders and providers. Can you share what you are hearing and feedback you have heard straight from operators in skilled nursing? Rumor has it, you did a little survey recently focusing on three questions of top providers and tenured experts in long-term care. Cassie Diner (31:43): Absolutely. And I'm proud to share with you what some industry leaders had to say about these upcoming changes and share their very helpful insights. I first asked some industry leaders what concerns their facility and staff the most about MDS changes coming in October? Because I'm sure many of you viewing this presentation have some concerns. Now one theme I noticed was the concern to familiarize ourselves with changes. This will be important as we continue to discuss how to complete this throughout today's session. GG training was another theme I noticed. First step to really figure out which type of staff is going to complete section GG documentation and thinking about the best way to train those types of users. Basically, Jenny, I continue to notice GG is really the big theme within responses, but I always laugh when I see GG because it reminds me of texting my friends that I got to go, but this section is definitely here to stay. Jenny Lee (32:41): That's too funny. And you're correct, section GG is here to stay for now. Another question, question number two, even though it's still seven months away, what is your strategy to prepare and train your staff? What did our industry experts say? Cassie Diner (32:56): Yeah, and training staff continues to be a hot topic. Many industry leaders discussed really pulling the key players within the organization together to have discussion calls around known changes, and what processes will need to be reviewed and potentially updated. Also, what training they require. Around training, it's apparent, many are looking at content, types of users, and selecting dates for training and go lives for process changes. Now, going back to your list, Jenny, I would encourage our audience to make a list of important recurring calls to gather key folks like MDS coordinators, gather key educators, and gather your detailed researchers. Coming together on a regular basis along the way will significantly decrease any surprises and increase collaboration of your full interdisciplinary team. Jenny Lee (33:47): These are great insights, as I think everyone needs to remember how many processes potentially need to be reviewed, changed, and trained. Not to mention how many people must come together with the entire interdisciplinary team on this and collaborate together. For the third and final question, we focused on what facilities need to update in their current MDS process. Cassie, take it away. Cassie Diner (34:11): Thanks, Jenny. Now this question also really spiked some interesting information around ensuring documentation is reviewed, revised and changes trained in order to capture data for MDS coding. For example, assessments or observations the staff currently utilize, and which documentation may directly import into the MDS, is something to consider. One of our industry experts also alluded back to all of the details that are still needed from CMS and state documentation. Jenny Lee (34:41): Now let's talk a little more about confidence in vendor preparedness. What can you be doing today to ensure your EHR solution vendor is prepared, working to prepare you, and on the right track leading up to October? As we mentioned previously, it starts with communication. Reach out to your vendor and ask what they have done to date to prepare. Where can you find the latest information, what webinars, recordings will be available, and what product training they're offering. As CMS publishes critical documents over the next few months, your vendor should be communicating updates out to you while working behind the scenes to make changes for October. Another thing you could do is have them point you to their experts, consultants, trainers, and thought leaders, people who translate in non-techy, long-term care friendly terminology, what the upcoming changes will mean for their EHR solution and most importantly, your organization. So Cassie, at a high level, where do we stand, as an industry, on all these changes? Cassie Diner (35:45): Well, we need to see additional documentation in May, or April and May, a matter of fact. Months are going to be huge for continued success leading up to October. As we mentioned previously, CMS is expected to release final MDS specifications and item sets in coming months. Digesting these, asking pertinent and detailed questions for clarity will be critical to success. We also need to see the updated RAI manual. It will likely include significant changes to some questions, and it will include chapter six, and chapter six is the PDPM calculation, which will be important to states as they transition from RUGs to PDPM. As an industry, in the absence of the final documentation from CMS and states, we are all still on track today. We know at a high level what's coming. We have suggested planning and lists to keep you busy as you prepare. (36:47): And as details are released, we're going to have to be agile and quickly digest and adapt to new information. Again, the best way to do this, as Jenny's poem and our next steps describe, is together. Now in summary, based on the draft forms, which included comprehensive quarterly PPS and discharge, there will be no path to producing the valid RUG score. The new MDS items mean you'll want to ensure your staff are prepared for change so they can feel confident knowing what is changing and the reasoning, and have a plan for implementing this change. There is still a lot of ambiguity among states, so let's stick together as we monitor, analyze, and digest new information as it comes available. (37:37): Travel lesson. As I said before, if you hear or see something, say something. Let's stick together across our states and vendors as new detailed information becomes available. In summary, we would like to thank you for joining us today. Your time is valuable and your choice to join us is greatly appreciated. Our goal is to bring you industry, thought leadership and education condensed in the most effective and efficient manner. Please don't hesitate to reach out with any questions today or in the future. We pride ourselves on our industry expertise, experience, and thought leadership. Speaker 2 (38:15): Thank you very much. We hope you found today's session informative. Before I sign off, I'd like to thank our speakers, Cassie Diner and Jenny Lee, as well as Ray Alameda for this session, and this session sponsor, Matrix Care. And thanks to all of you for being here. I and everyone else at McKnight's wish you a great rest of your day and a great rest of your online expo experience. Thanks for attending. Speaker 1 (38:40): That concludes the latest episode of the post-acute point of view from Matrix Care. We have a lot of guests and topics coming up that you won't want to miss, so be sure to subscribe. If you've enjoyed today's podcast, and if you have a topic you'd like us to discuss, leave us a review. To learn more about Matrix Care and our solutions and services, visit matrixcare.com. You can also follow us on LinkedIn, Twitter and Facebook. Thank you for listening. Be well and we'll see you next time.

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