This article from LeadingAge's MDS expert consultant, Judy Wilhide-Brant, RN, provides guidance on the 3 new MDS-based quality measures to be added to CMS Nursing Home Compare beginning April, 2016. She offers a guide to coding and highlights relevant insights to assist with answering the necessary questions within the section. 

In April CMS introduced two new MDS-based quality measures to NH compare.  These will be phased in to the Five Star Rating System by January 2016.  These measures are calculated using two ADLs in G0110 that have not been used before.

Percent of Residents Who Improved Performance on Transfer, Locomotion, and Walking in the Corridor (Short Stay)

This measure compares coding for Self-Performance for three mid-loss ADLs on the initial MDS (5 day or Admission) with coding on the Discharge Return Not Anticipated (DCRNA).     Residents with any of the following items coded on the initial MDS are excluded:

  • Comatose (B0100 = [1])
  • Life expectancy of less than 6 months (J1400 = [1])
  • Hospice (O0100K2 = [1])
  • Residents coded Independent in all three mid-loss ADLs (sum of G0110B1, G0110D1 and G0110E1 = [0])

And the following are also excluded: 

  • Missing data in any calculator fields on the initial or DCRNA.  (G0110B1, G0110D1, or G0110E1)
  • Residents with an unplanned discharge on any assessment during the care episode (A0310G = [2])

Example:

Initial MDS: 

            Transfers:  3
            Locomotion on Unit:  3
            Walking in Corridor:  8

 Total Score:  10  (7 and 8 are calculated as 4)

 DCRNA:

            Transfers:  3
            Locomotion on Unit: 3
            Walking in Corridor:  1

 Total Score:  7

 This resident would trigger as having improved performance on the mid-loss ADL score.

 Percent of Residents Who Declined in Independence in Locomotion (Long Stay)  

This measure compares coding on the target assessment for Self-Performance in “Locomotion on the Unit” with a prior assessment.  The prior assessment  ARD must be between 46 and 146 days before the target ARD.  The following items coded on the prior record are exclusions:

  • Coma
  • Six months or less to live
  • Hospice
  • 4,7 or 8 in Locomotion on Unit
  • Prior assessment is Discharge Assessment
  • No prior assessment
  • Missing data in QM calculator fields

 Example:

 Target MDS:

            Locomotion on Unit:  1

 Prior MDS:

            Locomotion on Unit:  0

 This resident would trigger because the ADL worsened from prior to target assessment.

 Correct coding for the three ADLs used to calculate both measures is crucial.   Let’s examine the ADL definitions from Chapter 3, Section G0110 of the RAI Manual.

G0110B1 Transfer: how resident moves between surfaces including to or from: bed, chair, wheelchair, standing position (excludes to/from bath/toilet)

This is one of the four late-loss ADLS used in RUG calculations and the older “ADL decline” QM.  It is likely must more familiar to staff members responsible for collecting and reporting ADL performance. 

G0110C1 Walk in room: how resident walks between locations in his/her room.  

This ADL captures walking in a very specific location:  the resident’s room.  Walking anywhere else is not captured here.  It may be time to evaluate how  CNAs or other staff members capture walking in the room when therapy or activities or other team members assist the resident in these locations.  A resident who is wheeled out of the room for walking assistance and never walked in the room would be coded here with “8 – activity did not occur.”

G0110E1.  Locomotion on unit: how resident moves between locations in his/her room and adjacent corridor on same floor. If in wheelchair, self-sufficiency once in chair.

This ADL is also location-dependent.  It is sometimes challenging to determine what is and is not the resident’s unit if the community is not a medical-model long hall wing of a traditional nursing facility.  If your residents live in small homes, is the porch part of the unit?  The yard?  The flower beds?   It’s time to make that determination.    The RAI manual offers no guidance and clearly assumes a medical-model physical structure.    Now that this specific ADL is captured in two new QMs that will be part of the Five Star System, it’s time to set some facility policies to define what a “unit” is when there are no “units,”  only home communities.