What's happening with HCFA's software mandate?

Not long ago it seemed as though the federal Health Care Financing Administration was going to require all nursing homes to be computerized, or have access to a computer service, by this October in order to process the MDS. That deadline seems to have disappeared, though, in the "now you see 'em, now you don't" world of government regulation -- subsumed by a massive revision underway of the MDS itself. But computer software is still very much in the nursing home picture, as discussed in this interview with Carolyn Harris, Director of Health Regulation and Planning for American Healthcare Software of Burlington, VT. Ms. Harris is also a nurse and experienced nursing home administrator. The questions were posed by Nursing Homes Editor Richard L. Peck.

Peck: What has happened in recent months regarding HCFA's proposed October mandate for computerization of the MDS?

Harris: That would be very difficult to achieve with the process that is underway right now to revise the MDS, followed by the provider training that will be required to update them.

Peck: What is the status of the MDS revision?

Harris: If all goes according to plan, HCFA will have completed its changes by late this summer. What specifically these changes will be is difficult to say at this point, but we can expect, for example, a new RAP summary worksheet; more comprehensive quarterly assessments; at least one new RAP guideline; more assessment questions relating to subacute care; and more clearly worded questions that don't leave so much to the judgment of staffers completing the forms. The revised MDS will be published in the State Operations Manual, and the states will then be required to submit their revised RAIs, including the changes, to HCFA for approval. This process is expected to run into early next year, at which point nursing homes themselves will be informed of the new requirements and trained in their documentation. So, under this timetable, we're talking about spring of 1995 for real action to take place.

Peck: Will computerization be mandated then?

Harris: Well, the push is still on. Probably "electronic submission" will be mandated, whether through a nursing home's own software or through a claims processing vendor. Then, too, HCFA is still very much involved in developing a computerized MDS national data base for implementation next year for continuous quality improvement.

Peck: So it is still in nursing homes' interest to give serious attention to computerization?

Harris: Very much so. I think more and more nursing homes are beginning to see the usefulness of computers in processing the MDS, both clinically and financially. It can expedite both care planning and reimbursement for care. Further, if you let your imagination run a bit, you can see many other uses for computers coming into play -- establishment of longitudinal norms to track resident care, the development of clinical pathways for subacute care, and performance of outcome studies, for example. Also, access to computerization can let the facility see itself as the state agencies see it -- for example, if the state is working with a computerized set of, say, 25 quality indicators, the facility can set up its program in such a way that it can see how it stacks up against the state's criteria. All of these are important considerations for nursing home management in the future.

Peck: What should nursing homes contemplating purchasing or expanding software systems be thinking about now?

Harris: It is especially important that they make sure that their software vendors are committed to keeping up-to-speed with regulatory changes; this should be part of their contractual agreements. It seems pretty clear that early 1995 is going to be a very busy time for everyone involved.