On October 1, 2023 the new MDS 3.0 goes into effect, presenting major changes to how care is documented and coded.
On October 1, 2023, the new MDS 3.0 will go into effect, presenting major changes to how providers code and document care. This blog is part of Polaris Group's Decoding the MDS 3.0 series which will explore the changes occurring in specific MDS sections.
Section J: All About Pain
Pain is a pervasive issue in nursing homes with up to 85% of nursing home residents reporting pain issues impacting their function and quality of life. Given the prevalence of pain and with increasing understanding that pain is a complex issue, the revised MDS 3.0 Section J now requires a more in-depth pain assessment for each resident.
Previously, the Pain Assessment Interview in Section J asked about pain presence and pain frequency only. In MDS 3.0, the Section J changes reflect a more comprehensive and holistic pain assessment. Now, the Pain Assessment Interview will require assessment of the following factors:
- Pain presence
- Pain frequency
- Pain effect on sleep
- Pain interference with therapy activities
- Pain interference with day-to-day activities
The goal of this in-depth assessment is to gain a deeper understanding of the resident's pain experience, leading to more personalized and effective pain management strategies.
What to Expect
- Determine plans to assess every resident. In MDS 3.0, every attempt should be made to complete the Pain Assessment Interview with each resident. Facilities should determine who will be completing the Pain Assessment Interview with residents and ensure appropriate training is in place, so all items are completed. If it is not possible to attempt the Pain Assessment Interview, MDS items J0300-J0600 will be skipped, and the Staff Assessment of Pain (J0800) will be completed instead. Further, assessment items will now ask the resident about the presence of pain “in the last 5 days” rather than during the “5-day look-back period”.
- Have your Cue Cards ready and set aside time for a more in-depth interview. CMS will provide a set of cue cards to assist with the pain interview. These cue cards provide written response choices residents will pick from to answer assessment items. For example, residents will be limited to these responses for the frequency of pain question: rarely or not at all, occasionally, frequently, almost constantly. The cue cards will assist residents to remember the available choices to ensure accuracy and efficiency of the interview. However, if a resident struggles to pick between response choices, the assessor should code for the option with the higher frequency. It is also important to note that no pre-determined definitions of response choice are provided to residents beyond the words on the cue cards. It will be up to residents to interpret what occasionally or frequently mean. As a result, assessors may have to help the resident narrow the focus of the response if the resident has difficulty selecting a single answer.
- Prepare to use findings to enhance pain management strategies. One of CMS’s goals in MDS 3.0 is to involve residents more actively in pain assessment and express preferences for pain management. Facilities should consider their pain management treatment protocols and ensure that Pain Assessment Interview results are leveraged to improve and individualize pain management strategies.
Recommendations from Polaris
Facilities need not wait until October to begin a more in-depth pain assessment. Right now, staff can begin training on the revised questions, practice administering questions with residents, and troubleshoot challenging coding situations.
Polaris Group can assist your facility with staff training on conducting the revised Pain Assessment Interview and how to code responses. Further, Polaris’s outsourced MDS coordinators are skilled at conducting in-depth pain assessment and communicating with residents to ensure accurate pain assessment. Lastly, Polaris consultants can review pain management treatment plans through chart audits and make recommendations to help facilities reduce the number of residents on inappropriate pharmacological pain treatments to improve resident and facility outcomes.
