MDS Alert

Get a quick 'heads up' on whether you're capturing residents' depression.

Residents with depression require more nursing time, right? So make sure you're not missing out on up to an extra $30 in extra payment a day in some cases to cover the costs.

Remember: Depression affects your RUG scores for clinically complex, said Marc Zimmet in a presentation at the most recent American Association of Homes & Services for the Aging annual meeting in San Antonio. "There are six clinically complex RUGs and half of them end in a 2 and half of them in 1," he said. The ones that end in a 2 are the ones in which the residents had depression ...quot; for example, CC2, CB2 and CA2. These RUGs pay more than the ones ending in a 1.

Do a "RUG run," looking at how many days you billed in each RUG for the past year, suggested Zimmet. See how many of your clinically complex groups end in 2's. If it's not as high as you expected, take a closer look. Either you're doing a great job at keeping depression in check--or your coding may be off the mark.

Know the stats: What percentage of residents might you expect to see with depression? "The MDS data for the fourth quarter of 2005 shows that 45.2 percent of people have a diagnosis of depression in Section I--and 46.9 percent are taking antidepressants," says Joanne Hayden, PhD, a quality-of-life specialist in Indianapolis. The prevalence may be even higher, however. Nurse consultant Jan Zacny believes up to 90 percent of people in nursing homes may have some level of depressed mood. "You're talking about people with ADL loss who aren't living at home," she says. "They are sick and they've had other losses."

To qualify for the depression end split in clinically complex, residents must be coded as having three or more indicators for depression, anxiety or sad mood during the 30-day lookback.

Don't throw money away: Double-check the resident's MDS assessment and coding for Section E1 anytime the MDS software shows a resident goes into one of the clinically complex RUGs that ends in 1, suggests Zacny, with BKD Southern Missouri in Springfield, MO.