MDS Alert

Find out why your coding for item G0110E1 is now more important than ever before.

Two important new quality measures (QMs) appeared on the Nursing Home Compare website in April and will begin to impact your Five-Star Quality Rating in July. But the even bigger part of this news is that your MDS coding will drive these measures.

3 Mid-Loss ADLs Produce Function QM

The MDS QM “Percent of Residents Who Improved Performance on Transfer, Locomotion, and Walking in the Corridor (Short Stay)” reports the percentage of discharged short-stay residents who gained more independence in transfer, locomotion, and walking during their episodes of care.

This QM essentially compares the MDS coding for Self-Performance for three mid-loss Activities of Daily Living (ADLs) on the initial MDS (five-day or admission) with coding on the Discharge Return Not Anticipated (DCRNA), according to a June 6 analysis by Judy Wilhide-Brandt, RN, BA, CPC, RAC-MT, C-NE of Wilhide Consulting Inc. for Washington, D.C.-based Leading Age.

Calculation: This QM’s numerator includes residents who have a negative change in performance score, meaning that the resident’s performance score declined from the five-day or admission assessment to the discharge assessment. If the resident has both admission and five-day assessments, CMS will use the earlier assessment.

The QM calculates performance as the sum of:

• G0110B1 — Transfer (Self-Performance);
• G0110D1 — Walk in corridor (Self-Performance); and
• G0110E1 — Locomotion on unit (Self-Performance).

Important: Any of the above three items coded as 7 — Activity occurred only once or twice or 8 — Activity did not occur are recoded to 4 — Total dependence.

The denominator includes short-stay residents who meet all of the following conditions:

1. Have a valid discharge assessment (A0310F = 10), AND
2. Have a valid preceding five-day assessment (A0310B = 01) OR admission assessment (A0310A = 01).

CMS excludes from the QM’s denominator residents with the following conditions:

• Comatose (B0100 = 1) on the five-day or admission assessment, whichever was used in the QM.
• Life expectancy of less than six months (J1400 = 1) on the five-day or admission assessment.
• Hospice (O0100K2 = 1) on the five-day or admission assessment.
• G0110B1, G0110D1, or G0110E1 missing on the discharge, five-day, or admission assessments.
• No impairment (sum of G0110B1, G0110D1 and G0110E1 = 0) on the five-day or admission assessment.
• Unplanned discharge (A0310G = 2) on any assessment during the care episode.

Look for Score to Decline

Wilhide-Brandt offered an example. On the initial MDS, Mrs. Jones scored the following on her self-performance mid-loss ADLs:

• G0110B1 = 3
• G0110D1 = 3
• G0110E1 = 8 (you would recode this as 4 for the calculation)

Then, Mrs. Jones scored the following on her DCRNA:

• G0110B1 = 3
• G0110D1 = 3
• G0110E1 = 1

Mrs. Jones had a total score of 10 on her initial MDS and a total score of seven on her DCRNA. Because she had a lower numeric score on discharge, the resident would trigger as having improved performance on the mid-loss ADL score.

Risk Adjustment Brings QM Down to Earth

Good news: For the functional improvements QM, CMS has built in some risk adjustments.

“Resident characteristics and clinical conditions influence the increase in independence made by short-stay residents on transfer, locomotion, and walking during their episodes of care regardless of the quality of care provided by the nursing home,” stated Dawn Murr-Davidson, RN, BSN, director of quality initiatives, and Rachel Delavan, director of research with the Pennsylvania Health Care Association in a recent training presentation.

To account for these resident characteristics and conditions, this QM includes covariates based on a resident’s status on the prior assessment regarding age, cognitive impairment, heart failure, stroke, hip or other fracture, and long-form ADL scale scores, Murr-Davidson and Delavan said. These risk adjustments should allow for fairer comparisons of nursing home performance.

Item G0110E1 Makes Another Appearance

The other new MDS-based QM is “Percent of Residents Who Declined in Independence in Locomotion (Long Stay).” This QM reports the percent of long-stay residents who experienced a decline in independence of locomotion during the target period. The target period is a comparison of a selected target assessment and at least one qualifying prior assessment.

This measure compares coding on the target assessment for Self-Performance in item G0110E1 — Locomotion on unit with a prior assessment, according to Wilhide-Brandt. The prior assessment’s Assessment Reference Date (ARD) must be between 46 and 146 days before the target ARD.

Calculation: For the numerator, CMS includes all coded values for item G0110E1. Again, any instances of coding 7 or 8 would convert to 4. Also, the numerator includes any instances of an increase of one or more points on item G0110E1 between the target assessment and prior assessment.

Locomotion Measure Contains Many Exclusions

The denominator for this measure includes long-stay residents who have a qualifying MDS target assessment and at least one qualifying prior assessment, except those with the following exclusions:

1. Comatose or missing data on comatose (B0100 = 1, -) at the prior assessment.
2. Prognosis of less than six months to live at the prior assessment:

   a. J1400 = 1, OR
   b. Hospice use (O0100K2 = 1), OR
   c. Neither indicator of being end-of-life at the prior assessment (J1400 ≠ 1 AND O0100K2 ≠ 1) AND a missing value on either indicator (J1400 = - OR O0100K = -).

3. Resident totally dependent during locomotion on prior assessment (G0110E1 = 4, 7, 8).
4. Missing data on locomotion on target OR prior assessment (G0110E1 = -).
5. Prior assessment is a discharge with or without return anticipated (A0310F = 10, 11).
6. No prior assessment is available to assess prior function:

   a. Target assessment is an admission assessment (A0310A = 01), a PPS five-day (A0310B = 01), OR the first assessment after an admission (A0310E = 01), OR A0310B = 06.

Example: Mrs. Jones scored a 1 for item G0110E in the target MDS and scored a 0 on the prior MDS assessment. In this case, the resident would trigger because the ADL worsened from the prior assessment to the target assessment, according to Wilhide-Brandt.

Link: To download the latest QM User’s Manual, go to www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/NHQIQualityMeasures.html.