Cat Without a Tail
Do you see a TIGER in your percentages when you expect a KITTEN? Are unexpected names on your Quality Measure (QM) Report for antipsychotic drug usage? Even the “appropriate” diagnosis of Schizophrenia will trigger the measure if not correctly reported. Schizophrenia, Tourette’s, and Huntington’s are the three accepted diagnoses for the use of an antipsychotic. Report these on the pre-printed section of the Minimum Data Set (MDS) Resident Assessment by checking I6000 for Schizophrenia, I5350 for Tourette’s Syndrome, and/or I5250 for Huntington’s Disease. In I8000 Additional active diagnoses, you may manually input “Schizophrenia with a tail.” One example is “Schizophrenia with Psychosis.” Please view CAT Tip #7 here: CAT_Tip_7. View more tips at http://primaris.org/tool. The Missouri Local Area Network for Excellence (MOLANE) is the state coalition for Advancing Excellence.
New Minimum Data Set (MDS) Sections I, G, M, and O provider training videos have been uploaded to YouTube. To learn more and access these videos, please visit the Centers for Medicare and Medicaid Services at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/NHQIMDS30TrainingMaterials.html.
Accurate completion of Section Q of the Minimum Data Set (MDS) is a requirement of the Centers for Medicare and Medicaid Services. This section is designed to provide residents who do not have current active plans for discharge, with an opportunity to speak with an outside resource (Local Contact Agency or LCA). The LCAs are contracted by the Division of Senior and Disability Services within the Missouri Department of Health and Senior Services.
Section Q is an interview process for all comprehensive MDS assessments and asks the following question in Q0500 of all residents who do not have current active discharge plans: “Do you want to talk to someone about the possibility of leaving this facility and returning to live and receive services in the community?” If the resident wishes to speak to an options counselor about a potential discharge, no matter how feasible the care plan team thinks discharge may or may not be, the facility is expected to make a referral to the LCA, at https://dssapp3.dss.mo.gov/mfpnursinghome/Login.aspx. (If the resident answers “yes” to Q0500, also indicate “yes” on question Q0600 and make the referral).
Please remember that this is a Resident’s Rights issue and the facility cannot skip asking the question in Q0500 unless there is current active discharge planning already occurring. The intent of Section Q is not to address residents who are already planning on discharge. The intent is to capture all of the long-term care residents who do not have active discharge plans. These are the residents who would be referred and benefit from speaking with an options counselor from the LCA. The only time Q0500 would not be asked of the resident is if they have a guardian or invoked durable power of attorney. In these cases, question Q0500 would be asked of the guardian/invoked durable power of attorney, rather than the resident.
For questions about Section Q of the MDS, please contact Joan Brundick, State RAI Coordinator at 573-751-6308 or Joan.Brundick@health.mo.gov.
CMS is tracking the progress of the Partnership to Improve Dementia Care in Nursing Homes by reviewing publicly reported MDS quality measures. The official measure of the Partnership is the percentage of long-stay nursing home residents who are receiving an antipsychotic medication, excluding those residents diagnosed with schizophrenia, Huntington’s Disease or Tourette’s Syndrome.
Since the Partnership began in 2012, this data indicates Missouri’s percentage rates have dropped every quarter, with an overall decrease of 9.17 percent. This is encouraging and shows that Missouri is making improvements towards decreasing the use of antipsychotic medications for residents with dementia when their use is not indicated or appropriate. Please view the trend update here: CMS Trend Update – Antipsychotic Drug Use in Nursing Homes.
QIPMO’s newsletter MDS Tips and Clinical Pearls – Volume 1, Issue 2 is now available online. Topics include Multidrug-Resistant Organisms (MDROs); MDS Coding – Sections I and O; and features Dave Walker’s Questions from the Field. Please visit www.nursinghomehelp.org/qipmo.html.