Latest / The Shift Ahead with Ken Bell / Can You Defend Your MDS? with Jennifer Napier
Transcript
- speaker-0: The biggest mistake leaders make today is just assuming that their MDS is accurate and reproducible. And when you're in the middle of an audit, it's almost too late to make those defensible changes to your documentation. speaker-1: I'm Ken Bell with Careability, and this is the shift ahead. Five minutes, three questions, and one expert, helping operators and clinicians prepare for what's coming next. Let's get into it. Why do so many SNFs still treat MDS accuracy as a reimbursement responsibility instead of an organization wide clinical and quality issue? speaker-0: I think it really comes down to the lack of understanding of the full scope and downstream impacts of MDS data. MDS completion and accuracy is not simply a billing function. It's essentially a system-wide data collection and input mechanism that directly translates that clinical information into data. That data on the MDS then drives reimbursement, regulatory outcomes, quality measures, and care improvement. Clinical coding directly influences how a resident is classified for payment. So getting the MDS right isn't about maximizing reimbursement. It's about making sure the organization is appropriately reimbursed for the care and services the resident actually requires. So an issue that may initially look like an MDS problem can ultimately become a quality or a reputation issue for an organization. If the data going into the system isn't accurate, you're potentially making quality improvement decisions based on inaccurate information. So ultimately, we need to move away from the mindset that the MDS is the responsibility of only the MDS department. That MDS department may coordinate the assessment process, but the accuracy of the assessment belongs to the entire interdisciplinary team and organizations. When organizations understand these connections, MDS accuracy stops being a departmental task and becomes part of the organization's overall culture of quality. speaker-1: As CMS expands data validation and VBP, what should providers be doing now to make sure their data is accurate and defensible and actually useful for improving performance? speaker-0: One mindset I encourage organizations to adopt is to ask a simple question. Is our MDS reproducible? I often challenge interdisciplinary teams with this one question. If I came behind you two months from now and coded the exact same MDS using only the medical record, would I arrive at the same scoring conclusion you did? And if the answer is no, or even I'm not sure. That's an opportunity to strengthen the assessment and documentation process. I really would like to emphasize that this isn't about creating documentation simply to justify a code after the fact. It's about accurately documenting the resident's clinical story as care is being provided. So often facilities might have strong internal processes to review their data before it's submitted. But we know that as our industry evolves and changes, sometimes the auditors and reviewers are looking for the next layer of support that's needed to support the MDS. speaker-1: Jennifer, what's the next shift that healthcare leaders should be preparing for? speaker-0: AI is going to fundamentally change healthcare as we know it today. And I don't think the question is whether we're or not we're going to use it. The question is how effectively and responsibly are we going to use it? We're increasingly moving from asking, what did we do to asking what was the outcome? What was the value? And can we demonstrate it? The organizations that ultimately are going to succeed here are not going to be the ones that adopt technology first. It's going to be the ones that learn to use that technology and leverage that technology responsibly, clinically, and strategically to strengthen care and not replace the human connection that makes healthcare meaningful. MDS accuracy at its core isn't just about reimbursement. It's about so much more than that. It's about painting an accurate clinical picture of the resident so that the facility can be reimbursed for the care that's being provided. And the facility can highlight the good quality care that's happening at the bedside.