Long-Term Care Survey Alert
Undo Inaccurate MDS Coding That Skews The Cognitive Impairment QI
PDF
Before you start chasing a high QI, take a deep breath and a step backwards.
Your smartest initial move in analyzing a high cognitive impairment QI: Look to see if inaccurate MDS coding could be the culprit.
"Understanding [whether that's the case] really starts with knowing which MDS items contribute to the QI," says Rena Shephard, RN, MHA, FACDONA, president of RRS Healthcare Consulting in San Diego.
Know the definition for cognitive impairment: "Cognitive impairment for purposes of the QIs/QMs is defined" as any impairment in cognitive skills for daily decision-making or "B4 is greater than 0," says Peter Arbuthnot, regulatory industry analyst with American HealthTech Inc. in Jackson, MS. "And B2a (short term memory) is coded as '1,' which means the resident has a problem with it."
The numerator for the QI looking at cognitive impairment includes residents coded as cognitively impaired at B4 and B2a on the target assessment who were not coded as impaired on the prior assessment. The denominator includes all of the residents who weren't cognitively impaired on the prior valid assessment.
Beware the consequences of miscoding: If you don't code these items correctly, your incidence of cognitive impairment will be off the mark.
A change in the MDS staff doing the assessment and coding may help explain a temporary bump up in the incidence of cognitive impairment that's now more accurate--or not. "The tricky thing about incidence-based measures such as cognitive impairment and depression indictors is that you have to make sure the MDSs are being coded consistently quarter after quarter," says Jennifer Gross, RN, BSN, a consultant with LTCQ Inc. in Lexington, MA.
For an inside look at how to code B4 and B2a, see the July 2006 issue of MDS Alert. For subscription information, call 1-800-874-9180.
Long-Term Care Survey Alert
- REVISED SURVEY GUIDANCE:
Get With CMS' Plan--Integrate Activities Into The Resident's Total Plan Of Care
Hint: Think of activities as part of the big picture.
As John Donne famously said, "No man [...] - QUALITY OF LIFE:
Help Your Facility Make The Grade With Its Activities Programming
Use this checklist to get your program in shape before the next survey.
You want your [...] - WOUND CARE:
Boost Positive Outcomes For Negative Pressure Wound Therapy
Outline and follow the do's and don'ts for this expensive therapy.
If your facility uses negative [...] - RISK MANAGEMENT:
Cognitive Impairment QI On The Rise? Give Your Overall Care Approach And Environment A Check-Up
If you don't, you're setting your facility up for a survey fall.
Think of a high [...] - MDS ACCURACY:
Undo Inaccurate MDS Coding That Skews The Cognitive Impairment QI
Before you start chasing a high QI, take a deep breath and a step backwards.
Your [...] - RESIDENT ASSESSMENT:
These Best Practices Will Help You Evaluate, Care Plan A Resident Triggering On The Cognitive Impairment QI
Identify what's wrong so you can help.
If you don't assess and care plan each resident [...] - RAI COMPLIANCE:
Determine Whether To Do A Sig Change
Here's what the RAI manual says to consider.
If surveyors see you've coded a resident on [...] - YOU BE THE SURVEYOR:
Determine The Level Of Severity For These Negative Psychosocial Outcomes
Find out how surveyors might cite 3 common scenarios.
Here are the answers to last month's [...] - CLIP 'N' SAVE:
Use This Calendar Form To Capture A Resident's Activities
Back-up documentation can head off survey woes. - CLIP 'N' SAVE:
Continued - SURVEY & CLINICAL NEWS
Ready for a new F tag for deficiencies in posting nursing staffing information? The Centers [...]