MDS Used to Assess Nursing Home Residents

Since 1991, nursing homes have been required to develop a plan of care for each resident based on the periodic collection of MDS data. In Medicare, these case-mix groups are known as resource utilization groups. As of January 2001, 18 states had introduced such payment systems for their Medicaid programs. Ten of these states’ reviews were in operation as of January 2001. States with Separate MDS Review Programs Emphasize On-Site Oversight, but Also Conduct Off-Site Monitoring

Nine of the 10 states with separate, longer standing MDS accuracy review programs use on-site reviews to test the accuracy of MDS data, generally visiting all or a significant portion of facilities in the state at least annually, if not more frequently. Requiring nursing homes to prepare corrective action plans and imposing financial penalties signal the importance of MDS accuracy to facilities and are tools to improve the accuracy of the MDS data. Recommendations for Executive Action

With the goal of complementing and leveraging the considerable federal and state resources already devoted to nursing home surveys and to separate MDS accuracy review programs, we recommend that the administrator of CMS review the adequacy of current state efforts to ensure the accuracy of MDS data, and provide, where necessary, additional guidance, training, and technical assistance;   monitor the adequacy of state MDS accuracy activities on an ongoing basis, such as through the use of the established federal comparative survey process; and   provide guidance to state agencies and nursing homes that sufficient evidentiary documentation to support the full MDS assessment be included in residents’ medical records. Without adequate documentation, it is unclear whether the nursing home staff sufficiently observed the resident to determine his or her care needs or merely checked off a box on the assessment form.
What GAO Found

Nursing homes that participate in Medicare and Medicaid must periodically assess the needs of residents in order to develop an appropriate plan of care. Such resident assessments are known as the minimum data set (MDS). According to officials in the 10 states with MDS accuracy review programs in operation as of January 2001, these programs were established to set Medicaid payments and identify quality of care problems. Nine of the 10 states conduct periodic on-site reviews in all or a significant portion of their nursing homes to assess the accuracy of the MDS data. These reviews sample a home's MDS assessments to determine whether the basis for the assessments is adequately documented in residents' medical records. These reviews often include interviews of nursing home personnel familiar with residents and observations of the residents themselves. States with separate MDS review programs identified various approaches to improve MDS accuracy. State officials highlighted the on-site review process itself and provider education activities as their primary approaches. State officials also reported such remedies as requiring nursing homes to prepare a corrective action plan or imposing financial penalties on nursing homes when serious or extensive errors in MDS data are found. Following the 1998 implementation of Medicare's MDS-based payment system, the Health Care Financing Administration began its own review program to ensure the accuracy of MDS data.