Editor's note: This tip was originally published in April 2009. It has been updated with the lastest information on quality-reporting.
Accurately coding the Minimum Data Set (MDS) is important. It affects you and the facility in many ways:
- Most importantly, these data helps develop individualized care plans for residents.
- The data feeds the Quality Measure (QM) report -- your best tool to compare your home's rates to others in our state and across the nation and to identify areas for performance improvement project activities.
- Quality data reporting drives your Medicare Part A reimbursement.
- Surveyors review your MDS data before visiting your home.
- Finally, these data feed the Nursing Home Compare website and your 5 star rating, both of which are publicly available and used by families deciding on a nursing home.
The QM report designates one measure to capture pressure ulcers for long-stay residents. This measure is called "Percentage of long-stay high-risk residents with pressure ulcers." Accurate coding on the MDS is essential to ensuring your performance on this measure is accurately reflected. Here are some tips to help you code this measure correctly:
- Make sure you correctly identify wound types. If it is not a pressure ulcer, do not code it as such. MDS 3.0 has other areas to code other wounds.
- The QM report indicates how many residents could have developed pressure ulcers - this is the denominator for your home's rate. For the numerator, use the number of residents who actually triggered as pressure ulcers cases; these were coded as having a pressure ulcer. If the denominator seems low, check your home's coding of Activities of Daily Living (ADL). Residents who require extensive assistance with bed mobility or transfers fall into the high-risk category. See the Primaris Take the Weight flyer for more help. Accurate coding of ADL can increase your denominator and improve your overall rate.
- Stage 1 pressure ulcers are not reflected in the percentage on the QM report. Review your weekly skin reports and take note at what stage staff members are identifying pressure ulcers.
For more information on MDS 3.0, download the current manuals and technical specifications here.
In addition, the Missouri Department of Health and Senior Services provides expert help through our state RAI coordinator, Joan Brundick. Ms. Brundick can be reached at 573-751-6308 or firstname.lastname@example.org.
Missouri's QPIMO program also provides individual consultation, training and sponsorship of MDS support groups. You may also contact the QIPMO program at 573-882-0241 or www.nursinghomehelp.org. QIPMO also sponsors MDS support groups, which meet regularly around the state.
CMS also provides more MDS coding information online. Pressure ulcer resources are available www.moaha.org; www.nhqualitycampaign.org, www.primaris.org/pressure_ulcers, and www.mohealthcare.com.
- Pull your QM report TODAY and review the numerator and denominator.
- Review the MDS of each high-risk resident who triggered for a pressure ulcer to be sure coding is correct. (Too many? Review those who you suspect may not actually have a pressure ulcer to ensure they didn't have some other wound.)
- Conduct an audit to determine if ADL coding is being captured appropriately.
- After your weekly skin assessments, if you find Stage 1 pressure ulcers are not being identified, work with staff to understand the importance of quick identification and treatment to prevent further deterioration.