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From the desk of our CEO Kris Mastrangelo:
MDS 3.0 Staff Interviews
Late life depression affects about 6 million Americans age 65 and older, but only 10% receive treatment for depression. The likely reason is that the elderly often display symptoms of depression differently. Depression in the elderly is also frequently confused with the effects of multiple illnesses and the medicines used to treat them. Studies of nursing home patients with physical illnesses have shown that the presence of depression substantially increases the likelihood of death from those illnesses.
The MDS 3.0 introduces facilities to the PHQ-9© resident interview. Although most patients are able to successfully complete the interview process, a patient may be unable to participate in an interview or partially complete the interview which results in an incomplete interview. The patient interview for mood is successfully completed when the patient answered the frequency responses of at least 7 of the 9 items on the PHQ-9©.
If symptom frequency is blank for 3 or more items, the interview is deemed not complete. The total severity score should then be coded as "99" and the staff assessment of mood should then be conducted. Alternate means of assessing mood must be used for patients who cannot communicate or refuse or are unable to participate in the PHQ-9© patient mood interview. This ensures that information about their mood is not overlooked.
The assessor should interview staff from all shifts who know the patient best. The scripted interviews with staff who know the patient well will provide critical information for understanding mood and making care planning decisions. Ask the staff member being interviewed to select how often over the past 2 weeks the symptom occurred. Use the descriptive and/or numeric categories on the form (e.g., "nearly every day" or 3 = 12-14 days) to select a frequency response to determine how often over the past 2 weeks the symptom occurred. The frequency response determines the total severity score. If frequency cannot be coded because the patient has been in the facility for less than 14 days, talk to family or significant other and review transfer records for information to select a frequency code. The assessor should also take into consideration observations of the patient during attempts to complete the patient interview and the documentation in the patient's record.
In addition to clinical uses of the PHQ-9©, the total severity score is used to determine the patient's nursing RUG score for Medicare reimbursement. CMS values the resources facilities utilize to care for patients with depression as reflected in an incremental increase in the Medicare RUG for patients who are depressed. If the PHQ-9© is 10 or greater and a patient qualifies for a Clinically Complex or Special Care category, a depression add on is reflected in the RUG by a 2 at the end of the RUG (CE2 versus CE1). It is important that the staff assessment be accurately completed in order to receive reimbursement for the resources utilized by the facility to manage depression.
Contribution by: Keri Hart, Regional Director of Operations
Winter Webinars
December 14, 2010 MDS 3.0/RUG-IV Tips and Strategies for the Therapy Professional January 13, 2011 Administrator's/DON's Guide to MDS 3.0 January 27, 2011 MDS 3.0 for the Therapy Professional February 3, 2011 MDS 3.0 FAQs
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