MDS Alert

Plus: Senators ask GAO to investigate 5-Star Quality Rating System.

Certification and Survey Provider Enhanced Reports (CASPER) now show two Final Validation Report links in your validation report folder for each successfully processed submission file: one link for the text format and another link for the new XML format.

“Nursing home and swing bed users should select the Final Validation Report name link that displays adjacent to the green notebook icon to view the validation report in the text format to which they are accustomed,” the Texas Department of Aging and Disability Services instructed in a Sept. 29 alert. “The new XML formatted report is easily identified by the ‘XML’ reference on the icon and is used by software developers that develop MDS 3.0 data entry software.”

Resource: For more information on accessing your Final Validation Reports, see the QIES Technical Support Office’s (QTSO’s) Helpful Hints document at www.qtso.com/download/mds/MDS_3.0_Helpful_Hints.pdf.

Also, CMS has updated its Resident Assessment Validation and Entry (jRAVEN) software to Version 1.3.0. The jRAVEN software v1.3.0 includes updates/changes to the following:

• Item Sets;
• Data Specifications;
• VUT;
• HotKey;
• ICD-10;
• Help Contents/RAI Manual;
• New Disclaimer and CAM verbiage;
• Cosmetic Report;
• Enhanced Resident Match;
• Facility Information Display;
• Resident Lock/Unlock;
• Encryption;
• Server upgrade; and
• Database restore enhancements.

Note: If you haven’t upgraded to at least jRAVEN v1.2.0, you must do so before installing v1.3.0. You can contact the QTSO Help Desk at 1-800-339-9313 or help@qtso.com for additional instructions or assistance.

In Other News …

Good News: GAO Will Take A Hard Look At 5-Star Quality Rating System

The recent overhaul of the Five Star Quality Rating System has drawn much criticism across the long-term care industry, and now the major watchdog agency the Government Accountability Office (GAO) will scrutinize the system.

Several U.S. senators have requested that the GAO assess the nursing home Five Star system to make sure it’s accurate and useful to consumers, according to an Aug. 31 report by the CMS Compliance Group Inc. (CCG). Sen. Robert Casey, Jr. (D-Penn.), along with Senate Finance Committee ranking member Sen. Ron Wyden (D-Ore.) and House Committee on Oversight and Government Reform ranking member Rep. Elijah Cummings (D-Md.), announced that the GAO has agreed to review the rating system.

CMS overhauled the Five Star Quality Rating System back in February (see “Brace Yourself: Your Quality Ratings Could Take A Nosedive,” MDS Alert, Vol. 13, No. 2, page 19, as well as “Don’t Be Surprised If You Lost Valuable Quality Stars,” Vol. 13, No. 3, page 25).

The GAO will look for potential deficiencies in the rating system, but the senators want the GAO to specifically look for loopholes and other areas where facilities can fudge their data.

Cummings said in a recent statement that he has “serious concerns that some nursing home facilities were gaming the current ‘five-star’ rating system to mislead consumers about the quality of care they provide. I commend GAO for agreeing to review this system to ensure that it provides accurate and reliable information while encouraging all nursing homes to achieve a higher quality of care for our nation’s seniors.”

And if the GAO’s past track record is any indication of how its findings will influence future changes, you could soon face yet another overhaul of the Five Star system if the GAO makes significant recommendations for changes to CMS.

The GAO has not yet released a timeline for the review, CCG says. You can read the senators’ letter to the GAO at www.finance.senate.gov/newsroom/ranking/release/?id=5a0d83a8-8f1c-4457-a418-0c7ea65078e4.

Advance Your SNF’s Excellence In Pain Management

When your skilled nursing facility’s (SNF’s) long and short stay quality measures for patients who self-report moderate to severe pain become elevated above facility benchmarks or national averages, this can be worrisome. But instead of simply fretting over the statistics, you can use this occurrence as an opportunity to improve your current facility practices for pain control.

Strategy: “In order to improve the quality of care and quality of life of residents, it is important that SNFs establish and promote pain management goals within their facility,” stressed Kris Mastrangelo, president and CEO of Harmony Healthcare International Inc., in a Sept. 25 company blog posting. Effective pain management can prevent the potential negative effects on residents of uncontrolled or unmanaged pain, such as a decline in functional status, increased risk of depression, and a decline in quality of life.

Also, pain management benefits nursing home staff in that staff members are more likely to experience enhanced job satisfaction and they’ll have the tools and resources to address various aspects of pain management to enhance care quality, Mastrangelo noted. And your facility benefits from pain management because you’ll have more satisfied residents and families, which translates into better care and image in the community, as well as improved quality measures due to better resident care and satisfaction results.

Try this: Follow these tips from Mastrangelo to achieve your facility’s pain management goals:

Identify and establish baselines within your SNF:

• Document your work, and monitor your outcomes and the processes related to your outcomes;

• Collect data for several months to establish a solid baseline; and
• Set a target for your improvement and continue collecting data.

Investigate potential causes for a higher result for pain quality measures. Consider interviewing techniques and practices to determine whether they are consistent and that interviewers are not unnecessarily “screening out” residents from the resident interview process;

Examine your facility’s current pain control practices, and consider making this process a Continuous Quality Improvement (CQI) project or Performance Improvement Project (PIP) for your Quality Assurance team. You could include as CQI/PIP outcomes patient reports of overall satisfaction with their stay and positive perception of their SNF/long-term care experience.

Resource: Improving pain management is a goal for the Advancing Excellence in America’s Nursing Homes Campaign. You can find out more about the Advancing Excellence Pain Goal at www.nhqualitycampaign.org/goalDetail.aspx?g=pain.