Functional Performance and Care Plan Quality Measure: MDS Section GG

MDS Section GG

In October 2016, all skilled nursing facilities will be submitting a new admission and discharge MDS for all Medicare fee-for-service beneficiaries. The purpose of the new admission and discharge assessments is to gather information for the quality reporting program (QRP). Specifically, there is a new MDS Section GG that required for only your Med A patients at admission and discharge. No other payers are included in this quality measure.

Why are we doing this?

Medicare was required by the IMPACT Act of 2014 to implement a QRP in post-acute care (PAC) settings. So the deadlines are firm and this is happening.

What is the QM?

The percent of your Med A PAC patient’s with an admission and discharge functional assessment and a care plan that addresses function. The functional assessment is the MDS Section GG and in the admission assessment at least one item must have a goal reported.

What makes MDS section GG different?

  • There is a 3-day look-back
  • The “usual performance” is scored, not the highest, lowest
  • The scoring scales is different and there is no rule of three
  • It has a goal requirement

How do we set the goal?

At least, one item in Section GG on the admission assessment will need to have a goal, there is no guidance as to which item(s) has the goal. If the patient is on therapy caseload, therapy will have goals set in the evaluation and will be able to provide a recommendation on the goal item(s) and how to score the goal. If the patient is not on therapy caseload, therapy may assist as needed through IDT collaboration. We will also provide training that will help nursing self-determine goals, understanding that the goal in this instance is where you expect the patient to be functionally at discharge and may not indicate an improvement.

Who should complete this section?

First, understand that this is an assessment, CMS has emphasized this point. Not all of the items may be naturally observed and scored. Second, this is also not solely a therapy MDS section like the therapy days and minutes in Section O. However, therapy does treat over 90% of the Med A PAC patients and will be performing this assessment. Therapy will be able to provide you with scoring and input. Remember that the MDS is considered and interdisciplinary team (IDT) effort and input from nursing staff, other staff, family, and therapy may inform the decision of the MDS coordinator on how to score Section GG for the usual performance.

Can this affect your reimbursement if not reported correctly on the MDS?

Yes! If a minimum threshold of 80% of your assessments do not report the quality measure such that the measure may be calculated, then there will be a 2% penalty in FY 2018 (October 2017). This means no dashes on the MDS for MDS Section GG. There are scoring options to indicate why an item could not be assessed and those must be used instead of dashes. Medicare’s training has been adamant about this point.

What will HTS do for me?

HTS uses Rehab Optima (RO) software, we have been collecting the data set items from the Mobility and Self-Care scales out of the CARE Tool for two years. The items in Section GG on the MDS came from these scales so our staff is already skilled at completing and scoring the assessment.

HTS is planning the following:

  • RO reporting for the Section GG is available now, we will have changes in RO early August to provide the MDS coordinator with a specific report such as we do for Section O.
  • HTS is developing training (early August) in-line with Medicare’s training to assist nursing staff in assessing those few Med A PAC patients that are not on the therapy caseload. This training includes a crosswalk between the scoring for therapy services, Section G, and Section GG to assist with training and understanding of the differences.
  • HTS staff will collaborate with the IDT to help score the Section GG items by for the 3-day look-back including goal setting.

Healthcare Therapy Services Commitment

HTS is your partner in therapy, we knew this was coming which is why we committed to having all of our staff trained and certified in the Mobility and Self-Care assessment, why we require those assessments in our evaluation and discharge documentation, and why we are prepared to help report, collaborate, and train your staff.

 

 

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