20020320-Minimum Data Set (MDS) — Testimony to the Health and Human Services Regulatory Reform Hearing, Phoenix, AZ, March 20, 2002

Minimum Data Set (MDS) — Testimony to the Health and Human Services Regulatory Reform Hearing, Phoenix, AZ, March 20, 2002

March 20, 2002
Phoenix, AZ

Minimum Data Set (MDS)

Good Morning. My name is Sue Zevan and I am a Registered Dietitian working for the Aging and Adult Administration in the Arizona Department of Economic Security. This is our state unit on aging that administers the Older Americans Act in AZ. I am responsible for the areas of nutrition and health promotion and I want to see that seniors get good nutrition care to improve their health. Prior to this job I was a consultant and had some contracts with LTC facilities so I would like to address the MDS.

It is important to have a good assessment of the patient in a timely manner to be able to treat the patient appropriately and effectively. The MDS was developed to provide a standard tool to achieve this. However the nutrition assessment portion is not consistently done by the same type of staff in each facility. Some are done by an MDS coordinator who might be a RN, some by a Dietary Manager or Dietetic Technician. Other facilities might have a RD complete them. Depending on the number of hours an RD is at the facility, she/he may not do an initial visit for one to two weeks.

Medical Nutrition Therapy by a Registered Dietitian has been shown to be a cost effective method of intervention and treatment of disease. It can also be a cost effective method for prevention and treatment of malnutrition, a common problem in the elderly. It can only be effective if the RD has time to evaluate and follow up with patients. Consider the differences in the nation:
In Oklahoma a 100-bed LTC facility might have an RD for eight hours a month, in AZ it might be eight to 16 hours a month and in Ohio it might be eight hours a week.

Most would agree that standardized assessment is necessary but most facilities would agree that the current system of MDS and RAPS is cumbersome and is seen as a financial burden with all of the documentation and the rate of reimbursement of the Prospective Payment System. Perhaps it’s time to evaluate the cost effectiveness of MDS and RAPS in relation to staff time and outcomes in terms of the patient’s quality of care.

For positive outcomes and good quality of care we need to have RDs in LTC facilities consistently across the nation, supported by legislation, with enough time to provide Medical Nutrition Therapy for the patients.

Submitted by:
Sue Zevan, RD
Staff Nutritionist
Aging and Adult Administration
1789 W. Jefferson #950-A
Phoenix, AZ 85007
602/364-0898
szevan@mail.de.state.az.us