This post is part of the MDS 2023 Countdown series. Disclaimer. Current as of December 16, 2023
WHAT YOU CAN EXPECT TO SEE
CMS does not require the completion of the physician examinations and orders, but they remain a requirement for some states for reimbursement with case mix.
However, CMS provides a convincing perspective of their benefit for enhancing quality of life and planning for care.
CMS communicates to us in the RAI Manual:
O0600: Physician Examinations
Item Rationale
Health-related Quality of Life
- Health status that requires frequent physician examinations can adversely affect an individual’s sense of well-being and functional status and can limit social activities.
Planning for Care
- Frequency of physician examinations can be an indication of medical complexity and stability of the resident’s health status.
CMS also states in the RAI Manual:
O0700: Physician Orders
Item Rationale
Health-related Quality of Life
- Health status that requires frequent physician order changes can adversely affect an individual’s sense of well-being and functional status and can limit social activities.
Planning for Care
- Frequency of physician order changes can be an indication of medical complexity and stability of the resident’s health status.
What is Changing?
Physician examinations and orders were removed with the release of the draft MDS 3.0 v1.18.11 version.
States requiring completion for Case Mix Index (CMI) know the benefit to capturing orders and visits to increase the state RUG. But the greater benefit is to the resident. While completing the MDS, trained clinicians use the orders and visits to create a snapshot of the resident. For example, what treatments have been provided and what is missing?
The MDS nurse – with the Interdisciplinary Team (IDT) – uses this information to create a care plan based on the resident’s holistic assessment.
As stated in F-tag 675:
“Quality of life is a fundamental principle that applies to all care and services provided to facility residents. Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being consistent with the resident’s comprehensive assessment and plan of care.”
What do the Changes Mean?
Elimination of the physician examinations and orders affects the Medicaid Reimbursement at a state level.
Case mix states use a weighted system to calculate the acuity need of the resident. Monitoring physician examinations and orders increases the score for Medicaid Reimbursement.
Like some of the other sections that have been eliminated from the draft MDS 3.0 v1.18.11 version, questions arise about Medicaid Reimbursement. What will the case mix states do for Medicaid Reimbursement?
Recommendations from MDS Consultants
Do not wait! To be ready for the finalized versions of the MDS assessments, MDS Coordinators and other members of the interdisciplinary team should begin preparing NOW!
Facilities will need to implement a system to ensure Physician visits and orders are being reviewed and integrated into the current plan of care. The plan of care should include the resident’s preferences, goals, and needs.
Facilities will also need to prepare for their state’s transition for Medicaid Reimbursement.