Long term care facilities will be required to electronically submit staffing information based on payroll to CMS beginning July 1, 2016. CMS will use the data to monitor staffing levels and employee turnover and tenure, which can impact the quality of care delivered.
Facility staffing information will be posted on the CMS Nursing Home Compare website used in the Nursing Home Five Star Quality Rating System.
CMS Staffing Data Submission Source Documents and Training Materials
Nursing care plans are usually arranged into the three parts of Care Plan Problem, Care Plan Goal, and Care Plan Interventions.
Problem statements are traditionally based on a nursing diagnosis. The nursing diagnosis is a problem that nurses can identify and treat. Medical diagnoses can be part of the nursing care plan problem statement, but not the actual problem itself. The most commonly used nursing diagnoses are the ones approved by NANDA, the North American Nursing Diagnosis Association, and are grouped by functional health patterns.
The goal can be to prevent a potential problem from occurring, to maintain a present status or level of functional ability, or to resolve a currently existing problem. Goals are usually stated in terms of an action the resident will perform.
Interventions describe specific actions taken by the staff to achieve the stated goal, and are based on standards of clinical practice. Like the goals of nursing care plans , interventions need to be specific, measurable, appropriate, and realistic. Interventions are worded in terms of what the staff will do to assist the resident to meet the stated goals for the problem.
Evaluation is an ongoing activity that examines the problem itself, the goals, and the interventions to determine if they are still applicable or if changes to the care plan need to be made.
See how these principles are applied by viewing these sample care plans:
Communication Nursing Care Plan
Vision Nursing Care Plan
There are many ways the MDS coordinator can increase the reimbursement level of the facility. While quality of care is the top priority, working to get the top level of payment that is justifiably due for services is of the utmost importance. Increased funds produce more resources for care.
Know the Federal and State Regulations. MDS data and documentation out of compliance due to errors or lateness risk having assessments being paid at the default rate, the lowest rate of payment.
Be familiar with the documentation requirements of skilled care. Knowing the requirements of skilled care provides opportunities to spot residents falling into higher reimbursement levels upon admission or when the level of needed care changes. Making sure the required documentation is in place assures that the facility will be paid for those services.
Know the criteria for RUG IV categories. Many elements of the MDS effect the RUG IV categories, and being familiar with them will help spot aspects of care that might otherwise be overlooked.
Use Grace Days to capture a higher RUG IV score. One of the reasons the Grace Days exist is to enable the facility to capture services for higher reimbursement. Work with the Therapy departments to set the ARD to capture higher Rehabilitation categories.
Monitor residents for changes that could alter the level of care. Scheduling Significant Change assessments when they are needed not only keeps the Care Plan appropriate for the resident’s needs, but it can also capture higher payment rates do to the increased need for care. Read the 24 Hour reports, attend Stand-up meetings, and examine the Physician’s telephone orders daily to catch changes.
Schedule assessments to capture higher RUG IV categories. Although Quarterly assessments can be no later than 92 days of the completion date of the last assessment, it is perfectly legitimate to schedule them earlier than the 92 days.