“What do you do for a living?” It may not surprise you that when asked this question, most MDS Coordinators struggle to come up with an answer. The reality is that MDS Coordinators fully understand what this multifaceted job entails, but are at a loss of how to put it into words for someone who isn’t out there doing it every day. This refresher on the basics of MDS Coordination should help answer that basic question quickly, completely, and in such a way that is easy to grasp.
What Does MDS Stand For?
MDS stands for Minimum Data Set, which is truly not ‘minimal.’ The MDS is an interdisciplinary assessment for nursing home residents (who may be long term residents and/or receiving rehab) that helps capture each resident’s health needs, functional abilities, cognitive status, and psychosocial status for a variety of purposes. These MDS assessments are required to be regularly submitted to the Centers for Medicare and Medicaid Services (CMS).
MDS, RAC, or NAC Coordinators?
The MDS Coordinator is typically a Registered Nurse due to the complex nature of the data collection and care planning – as well as the federal requirements the RN signs for the completion of the MDS. The MDS Coordinator is responsible for overseeing the Resident Assessment Process, also known as the RAI Process. This explains why most prefer to be called a Resident Assessment Coordinator (RAC) or Nurse Assessment Coordinator (NAC) instead of a Minimum Data Set Nurse. Other terms that may be appropriate for the manager of this position are MDS System Manager and Clinical Reimbursement Specialist. Regardless of the term used, completing the MDS is just the beginning of the role.
Where Did the MDS Come From?
The Omnibus Budget Reconciliation Act (OBRA) of 1987 is considered the birth of the MDS. The MDS comes with instructions called the Resident Assessment Instrument (RAI) – commonly referred to as the RAI manual. Through the RAI manual and MDS, OBRA established the requirement for a nationwide, comprehensive, standardized, reproducible assessment of each resident’s functional status. Over time, this data collection has expanded to include health, cognitive, and psychosocial evaluations as well as incorporated evaluations of resident preferences.
Why Have the MDS?
CMS uses the federally-mandated MDS assessment to compare quality among Nursing Homes nationwide; it also allows for comparison of quality among Nursing Homes within each state. When a Resident Assessment Coordinator (RAC) completes an MDS assessment and submits it to the federal government, the data collected is used to help improve the quality of care and quality of life for residents in nursing homes.
What Are Care Area Assessments (CAAs)?
Completion of the comprehensive MDS assessment triggers Care Area Assessments (CAAs), which are the link between the MDS and the Care Planning Process. Care Area Assessments consist of 20 areas of concern that are common for nursing home residents and which may require a more in-depth clinical assessment based on each resident’s unique health needs, functional abilities, cognitive status, and psychosocial status. The RAC uses the clinical record, resident interviews, the resident’s medical history, causes, contributing factors, lab values, physician consults, complete physical assessment, and any other pertinent information to investigate each relevant care area. The RAC then integrates this information using clinical judgment, critical thinking skills, and evidence-based nursing practice to arrive at conclusions about the resident’s status, needs, problems, and strengths to create an individualized resident care plan.
What Are Care Plans?
A written care plan documents what the facility must provide to ensure a resident receives effective, person-centered care. The care plan is designed and created to meet each resident’s unique preferences, needs, strengths, and goals as they relate to their health status, functional abilities, individual cognitive and psychosocial needs, and safety. When each resident’s preferences and goals are the center of the care plan, the approach to the resident’s care becomes holistic. Holistic care requires the support of the interdisciplinary team (IDT) to ensure that the care plan promotes the resident’s highest quality of life. Often the RAC coordinates updates to the care plan as the resident’s needs and goals change, and in doing so, the RAC facilitates coordination of care and services between the various interdisciplinary team members.
Why is the MDS So Important?
When the MDS was first introduced 30 years ago, it was a basic functional assessment. While the MDS remains a functional assessment, it has evolved into much more. The MDS is now used for Medicare and Medicaid reimbursement; quality measures; and to set nationwide thresholds for quality care. MDS information informs quality initiatives such as the 5-Star Program on Care Compare; Value-Based Purchasing; and the Quality Reporting Program. The acuity and census information from the MDS impacts expected staffing ratios. State surveyors pull information from the MDS that is specific to the facility during the annual survey. The RAC must have a working knowledge of the programs mentioned above, and an understanding of how MDS data affects each one.
Who Can Become an MDS Coordinator?
The ideal candidate to become a RAC is a nurse with excellent assessment and documentation skills. Successful RACs are detail-oriented, utilize the nursing process, and use critical thinking to advocate for each resident through holistic care planning. The RAC is an administrative nurse that is a leader and an educator. She/he becomes the ‘right-hand man’ to both the Administrator and the Director of Nursing Services in managing impacts to reimbursement and quality measures. The RAC learns to utilize resources such as the RAI manual, Medicare Benefit Policy Manual, MDS 3.0 Quality Measures Manual, Claims-Based Quality Measures Manual, and the 5-Star Users Guide. The competent RAC has some form of formal training, and it usually takes a new RAC about a year to feel comfortable in the role.
Is there a Certification Program for MDS Coordinators?
The RAC may earn certification through a national organization, such as the Resident Assessment Coordinator – Certified Program (RAC-CT) through the American Association of Post-Acute Care Nursing (AAPACN). Experienced RACs may choose to pursue advanced training to become a specialist in clinical reimbursement. The RAC may also earn the RAC-CTA, which is an advanced certification focusing on advanced principles of clinical reimbursement, Medicare compliance, RAI/MDS process integrity, leadership, ICD-10 CM accuracy, quality measure improvement strategies, and managing medical reviews.
“So….What Do You Do For a Living?”
When asked what you do for a living, the response from a RAC should be:
“I am a nurse with a specialty in resident assessment coordination. I conduct assessments that help improve the quality of care for residents in my facility and nursing homes nationwide. I ensure that the care plan has a holistic approach and is centered around the resident’s wants, needs, and goals for care. I have a working knowledge and monitor quality measures and quality initiatives. I am a resource within my facility on Medicare and Medicaid reimbursement. Most importantly, I am an advocate for resident-centered care and quality of life.”