CMI - RUG Consulting

CMI – RUG Consulting

MED e-care provides CMI-RUG Consulting Services to a number of complex continuing care and long-term care facilities throughout Canada. We evaluate the expected case-mix and care level of residents to optimize the facility’s CMI-RUG score and help maintain or increase current funding levels. The main purposes of this evaluation are: determination of case-mix, projected funding levels and key areas of documentation that require refinement to facilitate optimizing the case-mix classification within an organization.

Each quarter our experts scan across each of the months and provide 3 distinct phases for each of them, consisting of:

  • Monthly calls and/or visits to evaluate with staff the documentation for those residents whose CCRS assessments are due.
  • The calls/visits utilize reports generated from MED e-care’s proprietor MDS algorithm software; these reports, used for the monthly CMI-RUG conference calls, consist of decision tree analysis which have been collapsed based on the::
    • 105 RUG indictors
    • ADL, CCL and BDL scores
    • CPS scores
    • Diagnosis from both the CCRS and Care Plans
    • Progress notes and identified incidents
    • Alerts
    • Previous CCRS-MDS scores
    • Medications
    • Physicians notes
  • Follow up calls and/or visits to ensure changes have been made in the system.
  • Monthly feed-back reports on CMI-RUG changes.

Following are the 3 Phases that are carried out monthly, each quarter:

Phase 1
  • CCRS Data base is copied to the MED e-care’s proprietor MDS algorithm software.
  • Progress Note Incidents as well as specific Care Plan problems are folded into MED e-care’s proprietor MDS algorithm Report Decision Tree.
  • ADL, CPS and current RUG indictors are folded into MED e-care’s proprietor MDS algorithm Report Decision Tree Analysis.
  • Analysis of MED e-care’s proprietor MDS algorithm Report Decision Tree to identify 'outliers' in the CMI-RUG audit.

Pre-requisites for Phase 1:

  • Initial CCRS assessments to be completed
  • All care plans are to be up to date.
  • Access to the entire resident record for those residents being audited.

Phase 2
  • Proceed with site review for each resident’s Care Plans, Notes, Physician Orders, ADT, POC, and Wound Tracker. CCRS-MDS software running through our algorithm Decision Tree Report, to refine level of care determinations from Phase 1.
  • Report final results to designated facility staff.

Pre-requisites for Phase 2:

  • Internal MED e-care meeting set up with our consultation team to evaluate the status of the reports generated from MED e-care’s proprietor MDS algorithm software.
  • The RAI and RAI back-up will be present during these calls/meetings.
  • Monthly meetings to review CMI-RUGs.
Phase 3
  • Follow up following CMI-RUG call/meeting to confirm that changes to the CCRS-MDS have been completed.

Pre-requisites for Phase 3:

  • CMI-RUG graph developed and sent to site, identifying RUG changes.

THE EVALUATION TEAM

In order to effectively meet the project’s objectives, the following specialized expertise is available:

  • Demonstrated skills in research, evaluation and statistical analysis,
  • Understanding of Complex Care and Long Term Care’s funding tool as it relates to Canada,
  • Skills in case mix and patient assessment
  • Most importantly our proprietary algorithm software that incorporates not, only the entire Electronic Health Record for analysis, but all staff.
OUR APPROACH TO THE PROJECT

The proposed approach incorporates the following characteristics:

Comprehensiveness

Recognizing the potential implications for funding and staffing as a fundamental component for the provision of services within each facility, the evaluation covers evaluation questions regarding the core areas of patient care.

Flexibility

Our approach is a responsive one, allowing for maximum involvement of the facility staff and representatives in order to ensure that all aspects of the project meet with their expectations.

Commitment to Quality

Our consultation team is committed to delivering a superior project while adhering to the project’s established timelines and budget.

Our approach incorporates the general stages of program development, from conceptualization through implementation and developmental stages to its final operational stage. Thus, the evaluation is designed to address the following fundamental questions:

  1. What is the current and past patient case mix at the facility?
    This question addresses the issue of what has been the level of care requirements at the facility.
  2. What is the projected case mix at the facility?
    This question looks at the extent to past and current trends in patient case mix might impact future resource and staffing levels.
  3. What do you feel your case mix should be at this moment?
    This question allows the consultant to determine if the case mix is truly reflective of the care demands in your facility.

In attempting to answer the above questions, the following evaluation activities will be conducted:

Collection and Analysis of Information

This component of the evaluation will address the questions regarding how the care provided has been documented and implemented.

Methods

Relevant existing data (ADL’s and CCL’s) will be accessed to develop the facility’s current and future case mix profile. Standard evaluative and statistical processes will be carried out.

Measures

The types of data to be collected will include:

  • 105 RUG indictors
  • ADL, CCL and BDL scores
  • CPS scores
  • Diagnosis from both the CCRS and Care Plans
  • Progress notes and identified incidents
Analysis

Analysis of the above data will include the following:

  • Statistical and classification models developed for Canada’s long term care sector.
  • Consideration of current and future MOH health policy related to the health care sector and the changing demographic topology.
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