Medicare Compliance & Reimbursement

Organize and execute an effective goal statement to achieve measurable outcomes.

Completing the MDS 3.0 is crucial, but you must take note of compliance requirements too. The Centers for Medicare & Medicaid Services (CMS) may not mandate a specific care plan “format,” but keeping it patient-centric will help you avoid issues.

Include 4 Crucial Components in Your Care Plan

Your comprehensive care plan should include measurable objectives and timetables, and should meet the resident’s medical, nursing, mental and psychosocial needs, Patsy Strouse, RN, the RAI Coordinator for Ohio, said in a recent presentation. Using the MDS as the starting point, you’re identifying areas of concern, as well as causes and risk factors related to triggered care area items.

When writing the care plan, the content should have four areas covered in-depth, stated Susan Newell, MA, CTRS of consulting firm T.R. T.I.P.S., Inc. in a recent presentation for Oklahoma Leading Age:

1. Issues: Problems, Needs, Strengths.
2. Goals: Specific, Measurable, Outcomes.
3. Approaches/Interventions: Accommodations, Adaptations, Assistance.
4. Disciplines: Interdisciplinary Teamwork.

For the issues component, you’ll need to write an “issue statement.” Newell provided the following definitions for each type of issue:

• Problem: A concern, condition, diagnosis, situation, or behavior that negatively impacts the person, requiring assistance, intervention, or concern. Examples: The resident’s pain interferes with his enjoyment of daily activities; the resident requires assistance when walking outdoors because he falls frequently; or the resident isolates himself in his room due to poor hearing.
• Need (Psychosocial): An emotion, feeling, or social interaction that is important to the person and should be recognized. Examples: The resident needs to feel useful and productive, has always helped others; the resident misses friends of her own age; or the resident has difficulty making her needs known because she speaks limited English.
• Strength: An ability, skill, talent, characteristic, or trait a person possesses that should be recognized, encouraged, and/or promoted. Examples: A resident speaks three languages (English, French, Spanish) and desires to remain fluent; the resident has a strong sense of humor that helps maintain his daily balance; or the resident finds strength in his Jewish faith and prays daily, using faith to cope with his health issues.

Make Each Goal ‘Dance’

Each goal should have a subject, verb, modifier, and timeframe. According to Newell, the goal statement should include:

• Who (resident)
• Will Do What (verb)
• How Often (numbers)
• Under What Conditions (descriptive)
• Why (outcome)
• By When (next review date)

Example: According to Strouse, a complete goal statement would be: “Mr. Brown will walk 50 feet twice daily within the next three months.”

Newell also illustrated the proper approach to developing a goal statement as “RUMBA”:

• R: relevant, realistic
• U: understandable
• M: measurable
• B: behavioral
• A: achievable

Think ‘Triple-A’ When Defining Approaches/Interventions

In a basic sense, your Approaches/Interventions “should identify what staff are to do and when they are to do it and when it will be evaluated by the RN for possible changes,” Strouse said.

For Approaches/Interventions, think “triple-A”: Accommodation, Adaptation, and Assistance, Newell instructed:

Accommodation — This involves “individual preferences regarding environment, schedules, and routines that are acknowledged and respected,” Newell said. You would identify and try to accommodate such preferences.

For example, Mrs. Smith says her morning prayers before eating breakfast at 8:30am, Newell noted. Or she requires extra padding on her wheelchair seat cushion for all outings.

Adaptation — This encompasses “changes to equipment, supplies, tools, leadership, and program to increase a person’s independence, enjoyment, or success,” Newell explained. For example, you might provide a resident with additional lighting and a hand-held magnifier for reading. Or perhaps provide a resident with color-contrast (yellow, orange, blue) stickers for her gardening tools.

Assistance — This involves providing “verbal and/or physical aid to the person,” Newell stated. For instance, you might place craft items to the resident’s left and within 12 to 18 inches reach. Or you might ensure sufficient staff at an activity for speedy transport for toileting.