The MDS coordinator should report to…?

Traditionally, the MDS coordinator reports to the director of nursing (DON). But is that the best organizational structure? What if we were to break the mold and shake things up? Consider having your MDS coordinator report directly to the administrator. The MDS (Minimum Data Set) is a direct link to reimbursement, consumer ratings and interdisciplinary teamwork. The MDS coordinator’s role goes beyond the nursing department and so should his or her position in the nursing home.

In a recent Survey & Certification memo, the Centers for Medicare & Medicaid Service (CMS) announced that it is in the process of developing an MDS-focused survey. CMS plans on beginning a pilot process in. According to the memo, the MDS-focused survey will review MDS 3.0 coding practices and associated care planning in facilities. This puts an additional spotlight on the importance of the MDS coordinator’s position. Any deficient MDS system practices noted during an MDS-focused survey can lead to citations.

When MDS coordinators report to their DONs, their position is subordinate to those they work closely with on the interdisciplinary team, including the social services, activities, dietary, billing and therapy departments. Placing MDS coordinators on the same organizational level as the other department coordinators creates a level playing field when it comes to getting the MDS job done. Furthermore, the MDS process is integral to the facility’s financial health, provision of high-quality holistic care and quality outcomes. It only makes sense that the weight and responsibility of this role be reflected in its organizational status.

In a study on MDS coordinator relationships and nursing home care processes, Piven and colleagues¹ noted that some MDS coordinators lacked connections to middle and upper managers who were integral to promoting care system improvements and information flow to care teams. The study concluded that the most successful MDS nurses were engaged in management decision-making activities. These organizational influences allowed the MDS nurses to effectively make good connections with other staff. When the MDS nurses were closely aligned with management, those managers were more positively disposed to successful MDS systems. The authors noted a higher level of understanding and investment by upper management to MDS system issues, in turn leading to enhanced outcomes.

Information flow—both upward to management and outward to direct caregivers—is essential for a successful MDS nurse whose role is critical in care plan development and care outcomes. Facility leaders should evaluate their organization’s internal structure to see how well it fosters clinical knowledge, resident-focused care and charting accuracy. Resident care practices can benefit greatly when the MDS teams and direct care teams are in close communication. When MDS nurses have limited exposure to nursing staff, the Piven study found, they are less able to foster good connections, information flow and a diversity of ideas about resident conditions. Facility management should consider an organizational structure that promotes a high level of interaction between all members of the interdisciplinary team.

The MDS is too often viewed as a data-collection tool, and the MDS nurse’s activities can be seen as no more than a nuisance. If facility staff seem to avoid engagement with the MDS nurses, the MDS system in that facility is likely broken. The Resident Assessment Instrument (RAI) process utilizes the MDS and Care Area Assessments to drive a holistic care plan. This process is designed to promote clinical competence, observations, interviewing, critical thinking skills and assessment expertise from all disciplines for the purpose of developing an individualized care plan. The care plan becomes each resident’s unique path toward achieving or maintaining his or her highest practical level of well-being, which is the mandate for all facility staff.

Should the MDS coordinator report to the administrator? With so much at stake, facility administrators are encouraged to take a hard look at this option for ensuring MDS system integrity. Regardless of what the organizational structure is at your facility, ensure that the MDS system is working well.

Judi Kulus, NHA, RN, MAT, RAC-MT, C-NE, is vice president of curriculum development for the American Association of Nurse Assessment Coordination.

REFERENCE

1. Piven M, Bailey D, Ammarell N, Corazzini K, et al. (2006). MDS coordinator relationships and nursing home care processes. Western Journal of Nursing Research 2006;28:294–309.

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