Paired Assessment Accuracy Report

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Paired Assessment Accuracy Report
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Paired Assessment Accuracy Report (PAAR)

• Purpose
• to provide nursing facilities with information
  regarding potential MDS coding discrepancies
• Intent
• to be a tool for provider self-audit
• Vision for the future
• first generation of provider feedback reports

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What is the PAAR?

• A report generated from the MDS national
  repository that evaluates pairs of sequential MDS
  assessments
• 5 and 14 day
• 90 and 90 day
• Intended to capture potential MDS coding errors
• assessments that do not change when the clinical
  condition of interest would be expected to have
  changed between the two assessments
• pneumonia at 14 days, bladder continence in
  cognitively impaired residents at 180 days

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Example Pneumonia

• MDS Item I2e
• Coded yes on both the 5 day and 14 day
  assessments
• Clinical rationale for this trigger
• pneumonia that persists at Day 14 for a resident
  who was admitted with pneumonia is oftentimes
  resolved by 14 days because it was treated in the
  hospital for several days prior to facility
  admission
• facilities that have a very large number of
  residents with pneumonia that persists between 5
  days and 14 days may have a problem with MDS
  coding of this item

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Example Bladder Continence

• MDS Item H1b
• Coded continent on two sequential quarterly (90
  day) assessments
• Risk adjusted for those residents who are
  cognitively impaired
• Clinical rationale for this trigger
• Long-stay, cognitively impaired residents are at
  great risk for bladder incontinence
• Facilities with high numbers of MDS assessments
  indicating continence on sequential quarterly
  assessments may have a problem with MDS coding of
  this item

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Sample PAAR

• Pneumonia Trigger Page
•  
• Pneumonia Trigger (MDS Element I2e)
• Total Residents with 5- and 14- day
  assessments 212
• Residents triggering 8
• Percent at this facility 3.7
• Compare with 8.2 nationally
• 9.4 State of State
• Definition of I2e Pneumonia
• Inflammation of the lungs most commonly of
  bacterial or viral origin.
•  
• Importance of Pneumonia as an MDS Accuracy
  Trigger
• Symptoms of active pneumonia may include elevated
  respiratory rate, cough, shortness of breath,
  chest pain, abnormal breath sounds, and impaired
  ADL or cognitive functioning. Although pneumonia
  symptoms may persist in a newly admitted facility
  patient and be coded on the 5-day assessment, it
  is unlikely that with treatment the pneumonia
  would still be active on the 14-day MDS
  assessment. A pattern showing a large number of
  cases where pneumonia is coded on both the 5-day
  and 14-day MDS may be indicative of a coding
  error.

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Sample PAAR, cont.
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How does the PAAR work?

• Reports made available through CASPER on-line
  reports
• Provider expected to
• Review report
• Select cases for review
• Review the documentation in the medical record
  for each of the MDS pairs to determine if MDS
  coding is correct
• Submit corrected MDS forms as needed
• Use knowledge gained from the process to improve
  facility coding practices

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PAAR Feasibility Tests

• Focus Group
• Six participants
• Nominated by AHCA, AAHSA, and AANAC
• Credentials involved in day-to-day MDS
  assessment activities
• Reviewed and provided feedback on early versions
  of reports and manuals

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PAAR Feasibility Tests, cont.

• Pilot Project
• 31 facility volunteers participated
• AR, IN, NH, VT, VA
• Results
• Reports easily accessed
• PAAR process aided facilities in improving their
  understanding of correct MDS coding criteria

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What can providers expect with regard to Feedback
Reports?

• National PAAR Release
• Fall 2003
• Access to reports via QIES
• Expectation that reports will be used by
  providers for self-audit
• On-going development and dissemination of other
  MDS accuracy feedback reports
• Eventual requirement that some action is taken by
  provider upon receipt of PAAR (or other feedback
  report)

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Thank you!