MDS GG Coming on October 1st

There are big changes facing the Interdisciplinary Clinical team (IDT) next month with the addition of the GG Section to the MDS. The additional section only applies to residents admitted for a skilled stay. The change is an effort to connect Post-Acute Care across the continuum, allowing providers to facilitate coordinated care efforts between care settings with the goal of improving patient outcomes. This will once again challenge the IDT to understand and implement the MDS changes that will have an impact on their organization’s quality outcome data.

Section GG Overview

Section GG pages 292 – 331 of the newly revised and recently finalized RAI Manual MDS 3.0 V1.14 require the assessor to assess the following items:

1. eating
2. oral hygiene
3. toileting hygiene
4. sit to lying
5. lying to sitting on side of the bed
6. chair/bed-to-chair transfer
7. toilet transfer
8. does the resident walk
9. walk 50 feet with two turns
10. walk 150 feet
11. does the resident use a wheelchair/scooter
12. wheel 50 feet with two turns
13. type of wheelchair/scooter – manual or motorized – to wheel 50 feet
14. wheel 150 feet and the type of wheelchair/scooter to wheel 150 feet.

IDT assessors need to be attentive to the following changes:

1. Timing of when the observations and assessment are to be made;
2. New “Admission Performance Assessment” and “Discharge Goal” and
3. New codes.

MDS Section GG focuses on the resident’s self-care and mobility in six new quality measures based on comparing the codes from admission, discharge goals and the resident performance at the time of discharge to identify if there has been progress when discharged from the skilled PPS stay. Section GG should not be confused with Section G.

The RAI manual provides detailed information of the new six-point scale that differs from current codes, but is seemingly similar to therapy terminology with different definitions.

Coding and Resources Tips to Assure the Whole IDT is on board:

Accuracy for coding the MDS is critical. It is important the IDT recognizes the differences of the MDS 3.0 GG from the rest of the MDS:

• Read the instruction for the coding of each item very carefully. Section GG of the RAI Manual, Chapter 3, GG pages 1-31 offers very clear instructions and some excellent examples on coding.
• Involve the therapy staff as they will understand the lingo and can help assess the functional assessments.
• Consider having PPS meetings to discuss discharges and to address the resident’s goals in the Plan of Care.
• The coding for Section GG is very different from what is used in Section G and needs to be studied, especially the difference for the six-point scale in section GG as it is in a reversed order from section G.
• Three options for coding have been added: resident refused, not applicable and not attempted due to medical condition or safety concerns, which is a special focus
• Dashes at no time should be used unless there are no other options. Use of dashes could result in the facilities quality measurement data not being generated, which could result in a loss of payment
• Read the descriptions of the codes as they are done very well and will result in clarity for the IDT.
• Therapy members of the IDT should be heavily involved in coding of GG as it is truly a functional assessment.
• Functional activities can be completed with or without the use of an assistive device.
• Coding should be based upon the resident’s “usual” performance or baseline performance, NOT the most independent performance and NOT the most dependent performance over the assessment period.
• Code the actual performance, NOT the staff’s assessment of the resident’s capabilities to do an activity.

Don’t forget or overlook changes to new MDS Sections C, J and M:

• Section C: No longer has Psychomotor Retardation. The new item is C1310A Acute Onset Mental Status Change. C1300 and C1600 have also be deleted. The changes on the MDS will change how the Delirium CAT is triggered as the new items are pulled in.
• Section J: Clarifies when a significant injury may not be present at the time of the MDS. A modification needs to be done to indicate a serious injury should a serious injury present after the ARD.
• Section M: Clarifies what is meant by “Present on Admission.” Provides examples regarding Pressure Ulcer present or not present on admission. Read carefully on how to record a pressure ulcer being present for a resident who goes and returns from the hospital.

Additional Resources:

Videos:

These short videos can be reviewed individually or as a team. The videos, produced by CMS, highlight the expectations of the changes to come Oct. 1:

• Section GG0130 Self Care: Overview and Functional Abilities and Goals (19 minutes):
• Section GG0130 Self Care: Coding Tips Items A- C (16 minutes)
• Section GG0170 Mobility B-C (17 minutes)
• Section GG0170 Mobility D-S (19 minutes)

The American Association of Nurse Assessment Coordination developed the following videos:

• Scheduling Part 1 (14 minutes)
• Definition Part 2 (22 minutes)

Materials:

• RAI Manual 3.0 v1.14
• MDS 3.0 Sect A and GG updated    

Thanks to Liz Sither of LeadingAge Minnesota for this article.

For More Information, contact Shirley L. Boltz RN, State RAI Coordinator/Education Coordinator at Shirley.Boltz@kdads.ks.gov or by phone at (785) 296-1282