Ongoing staffing shortages combined with regulatory headwinds have put even more pressure on nursing home MDS coordinators, a specialized position that has not been immune to the staff turnover felt across the sector.
And their role in ensuring facilities get the reimbursement they earn and the right care is provided may be more vital than ever with proposed Medicare cuts on the horizon.
Some operators, like Milwaukee-based North Shore Healthcare, have been looking for ways to make their MDS process simpler and more efficient by keeping their MDS coordinators focused on assessments and providing them with more regional support.
But as staffing issues have forced operators to rely more on MDS coordinators for patient care, this can sometimes be easier said than done, leaving them the choice between maximizing reimbursement and patient care.
“It’s unfortunate because they’re RNs (registered nurses) so they’re taken far too often and we’re trying to protect that,” North Shore owner and partner David Mills told Skilled Nursing News. “Long story short, automation helps, regional support helps, but there’s too much pressure on the ground from the guys that we need.”
As facilities need to maximize their reimbursement more than ever, one strategy that more and more operators have begun to implement is to use regional MDS coordinators and MDS “floats” to help with staff thinning. direct care.
“I had two conversations this morning with operators who previously may not have focused as much on reimbursement as others, but [with] some of the reductions coming in the proposed PDPM rule coupled with occupancy issues, staffing and rising costs, I’m starting to see an increased focus on reimbursement,” said Vincent Fedele, Partner of Zimmet and Director of Analytics at Zimmet Healthcare Services Group. SNN.
A short-term fix with long-term implications
Current staffing challenges have led to more nursing homes hiring MDS coordinators to work in the field and assist with patient care, but this strategy itself creates new problems.
“It’s fine for a day or two, but it’s a band-aid. Right now every RN you can find is trying to grab them,” Mills said.
With a $320 million Medicare cut proposed for 2023, the pressure on NFCs to most efficiently, correctly, and fully capture PDPM reimbursement will only grow.
Georgie Faulk-Sherwood, vice president of clinical reimbursement for Focused Post Acute Care Partners, thinks pulling MDS coordinators to the ground should be a last resort for SNFs.
“We always say we have to keep our MDS coordinators to a different standard, which means they can’t be on call unless it’s a categorical emergency, because they are our source of money,” Faulk said at the recent Skilled Nursing News clinical executives conference in Chicago. . “They have to be in the community, they have to assess these residents because they’re making your money.”
Yet with staff turnover as it is – the SNF industry added just 900 jobs in April after losing 2,500 jobs in March – operators often have little choice in the matter.
“Our MDS coordinators have gotten really good at being CNAs,” said Lorie Morris, senior vice president of assessment coordination for Prestige Healthcare, on the same panel at the Clinical Executives Conference. “Our coordinators spent time working as caregivers and one of them called us that she was going to cook in the kitchen.”
Morris would like to think that when MDS coordinators and nurses take care of residents or help dispense medications, they get to know residents better, which in turn could help with assessments, but that can lead to delays in documentation. and MDS coordination.
“Sometimes staffing like when an MDS coordinator is working in the field, they don’t get the quality documentation that I hope to see there,” she added.
The Polaris Group, a consulting firm that provides offsite and outsourced MDS coordinators to long-term care communities across the country, has seen MDS documentation fall months behind schedule at some facilities in part due to their need for these nurses to provide patient care.
“If someone isn’t there to give them medication, of course you’re going to pull your MDS nurse, or your DON, or whoever’s sitting in the office,” said Wendy Strain, director of counseling services at the Polaris group, at SNN. “But if at the end of the day, if you don’t provide the refund you deserve, how are you going to manage the building?”
Strain said it was an “easy fix” for that day, but if an establishment is consistently late and not watching the MDS in “real time”, that’s when things can happen. be missed with refund.
She saw MDS coordinators leave facilities because they were “overloaded” with patient care. Strain worked with a facility whose MDS billing and completion was two months behind schedule, so they were unable to bill following the resignation of their MDS nurse.
A two-month delay can translate into hundreds of dollars per day per resident left on the table to which the facility is entitled, Strain added.
Create more backstops for the MDS process
As staffing shortages persist, several companies like Zimmet Healthcare Services and The Polaris Group have seen an increase in their MDS services by adding more checks and balances through outsourcing and MDS “floats” have become a popular strategy for operators to ensure that the turnover does not affect the reimbursement of the PDPM.
“During Covid we found that many of our customers were in situations where they had no MDS or had an illness or had staff away for months so we came up with a plan to do MDS remotely offsite,” Strain said. “At first, I didn’t think it would work. I was old school and felt like the MDS nurse had to be there.
However, seeing some of the challenges operators faced with MDS accuracy and completion, Polaris began offering outsourced, offsite, remote MDS coordinators in January who would come in and support the department “as much as the operator wished”.
Strain said one of the benefits is that the service takes away the “temptation” for operators to use the MDS coordinator for patient care instead.
“I was talking about it with a CEO and owner and who said they wouldn’t have this MDS nurse to pull the floor and I said ‘exactly,'” she explained.
Zimmet has seen its MDS outsourcing platforms quadruple since October.
The consulting firm offers two types of MDS outsourcing opportunities to NFCs. The first is more of a temporary staffing model and if a staff member is absent, Zimmet comes to “plug a hole” in the short term.
The other is that Zimmet supports MDS functions more holistically and “leads the charge” in performing MDS assessments.
“In larger organizations, you’ll often see that they have their dedicated MDS person in the building, and then they’ll have some sort of floating person that plugs holes throughout the organization,” Fedele explained. “Option B is really conducive to this floating person, where we plug the holes and act as the flow coordinator in larger organizations.”
He added that it has become a very “scalable” approach and from a value proposition perspective is an “easy sell” as Zimmet leverages technology and workflow automation to improve the MDS process and make it more cost effective.
Others have tried to improve their MDS support internally.
“We have four Regional Clinical Reimbursement Managers who are pseudo MDS Coordinators who oversee a group of buildings and when we have an opening we can use them to help us,” Fedele said. “We must always have our eyes on the patient, but through [remote services] we can review the documentation and become more efficient on the MDS process. »
Strain has seen some operators follow this trend as well and others are trying to do it more internally by developing a pool of MDS coordinators.
On the other side, she has also seen an increase in the number of MDS nurses seeking remote work.
“Whether it’s with a company like ours or a corporate facility that’s willing to let the MDS nurse work offsite, the trend is huge,” she said. “If you take a look in the MDS Coordinator’s Facebook groups, you’ll find several groups and hardly a day goes by that someone doesn’t ask about how to get a remote job or on how to convince his owner-operator administrator that he could do a better job from home because of the distractions in a facility.