Harmony Healthcare Blog

Quality Measure: The Ability to Move Independently Worsened

Posted by The Harmony Team on Thu, Apr 26, 2018

Edited by Kris Mastrangelo


Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency

Young beauty doctor working in rest homeWe continuously hear the story told by Kris Mastrangelo about her experience at the Boston MS clinic years ago when she was convinced she had Multiple Sclerosis.  The Physician asked her to walk down the hall 50 feet, turn around, and walk back as fast as she could.  She was perplexed by the request, but even more curious as to why the Physician displayed a stop watch high in the air indicating she was being timed.   Why?  After much thought and a little research, Kris surmised that “the slower you walk, the sooner you die.” 

While that may seem oversimplified, multiple studies support this theory. 

A new analysis of walking speed studies shows that—down to the tenth
of a meter per second—an older person's pace, along with their age and
gender, can predict their life expectancy just as well as the complex battery
of other health indicators.”

Seeing there is a direct correlation between life expectancy and an individual’s ability to move and walk, it is logical that CMS tracks the Quality Measure reporting decline in the Long-Stay residents’ ability to mobilize (specifically, the resident’s locomotion on the unit). This metric has left staff perplexed, having not observed an obvious change or decline. 

It’s important to note that the Ability to Move Independently Worsened is a Long-Stay Quality Measure that is calculated based on MDS coding of item G0110E1 (Locomotion on Unit) for Long-Stay residents.   

A Long-Stay Resident is defined as a resident with cumulative days in the facility greater than or equal to 101 days as of the end of the target period.  The resident triggers this Quality Measure based the MDS coding of one item in comparing the residents target assessment with their prior assessment.  

The Numerator: 

  • G0110E1- Locomotion on Unit: how resident moves between locations in his/her room and adjacent corridor on same floor. If in wheelchair, self-sufficiency once in chair. 

The Denominator: 

  • Long-Stay residents who have a qualifying target assessment and at least one qualifying prior assessment, except those with exclusions. 

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Quality Measure Trigger: 

  • The resident with a qualifying MDS assessment who has experienced a one-point decline in Self-Performance in Locomotion on the Unit.  For example: 

  • Self-Performance on Target MDS Assessment:  3- Extensive Assistance
  • Self-Performance on Prior MDS Assessment:  2- Limited Assistance
    • 1-point change Prior to Target MDS = decline 
  • Self-Performance on Target MDS Assessment:  4- Total Dependence
  • Self-Performance on Prior MDS Assessment:  3- Extensive Assistance
    • 1-point change Prior to Target MDS = decline 
  • Self-Performance on Target MDS Assessment:  8- Activity Did Not Occur
  • Self-Performance on Prior MDS Assessment:  3- Extensive Assistance
    • 1-point change Prior to Target MDS = decline
    • The coding of 8, Activity Did Not Occur is calculated as Total Dependence 

This Quality Measure is affected by covariates.  Covariates are a set of resident clinical characteristics that adjust for potential differences in residents between facilities and thereby level the playing field. 

The following covariates are applied to the Quality Measure and accuracy in the following MDS items are of equal importance:  

  1. Eating
  2. Toileting
  3. Transfer
  4. Walking in corridor
  5. Severe cognitive impairment
  6. Linear age
  7. Gender
  8. Vision
  9. Oxygen use
  10. All covariates are missing if no prior assessment is available 

Residents are excluded from the calculation if outcomes are determined as not under the facility control in instances such as: 

  • the outcome is evident on admission or
  • if outcomes are unavoidable in cases such as end-stage disease or comatose. 

Exclusions to this Quality Measure include: 

  1. Comatose
  2. Prognosis of less than 6 months
  3. Hospice
  4. Resident totally dependent or missing data for locomotion on prior assessment
  5. Prior assessment is an OBRA Discharge
  6. No prior assessment
  7. Target assessment is an Admission or 5-day 

The Next Steps: 

  • Review the ADL data. 
  • Validate MDS coding on the Target MDS and prior MDS to determine if the trigger is actual or a product of inaccurate coding. 
  • Does the staff understand the definitions of the various levels of Self-Performance:  Independence, Supervision, Limited Assist, Extensive Assist and Total Dependence in Locomotion on Unit? 
  • Interview staff and consider all modes of locomotion on the unit.  Is staff considering all locomotion to include walking and wheelchair?
  • Has there been a recent change in wheelchair? 
  • Is the current wheelchair appropriate?
  • Has the resident become bedbound (8,8 Locomotion on the Unit equates to Total Dependence?)
  • Has the resident experienced a Significant Change in Status, supporting Interdisciplinary assessment? 
  • Has the Rehabilitation Team performed a screen? 
  • Is a Rehabilitation (PT/OT) evaluation warranted? 
  • Has the resident experienced weakness or another impairment that is causing difficulty in mobilization? 
  • Would   the resident benefit from development of a Restorative Nursing Rehabilitation Program to assist the resident to attain and maintain the highest level of function and independence?
  • Does the resident qualify for exclusions?
  • Determine if the applicable covariates are coded accurately, such as ADL and cognitive status? 

Hopefully, the above information will be useful in accurately coding the MDS.  But also, maybe it will motive all if us to walk a little faster. 

Harmony Healthcare International (HHI) performs monthly compliance audits. If you need help with this area, please contact us by clicking here.  Looking to train your staff?  Join us in person at one of our our upcoming Competency/Certification Courses.  Click here to see the dates and locations. 

[1] Walking Speed Predicts Life Expectancy of Older Adults
Baby Boomers who keep up the pace as they age are likely to outlive those who slow down
Katherine Harmon on January 4, 2011

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Tags: Quality Measures

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