A Closer Look at AANAC

S

upport is not to be overlooked, as too many clinicians involved in completing the Minimum Data Set (MDS) feel isolated and unsupported in this role,” states the website of the American Association of Nurse Assessment Coordinators (AANAC). Belonging to a national organization provides support, and if you are a resident assessment coordinator (RAC) you will learn a lot and receive support from belonging to AANAC. Its national convention for the fall will be held October 16–20 in Louisville, Kentucky, with more than 500 expected to attend. This article will spotlight AANAC so that you can understand that there is support for MDS professionals and how these types of organizations share valuable information to help you in your career.
       AANAC is a nonprofit organization dedicated to supporting clinicians who are involved with the Resident Assessment Instrument (RAI)/MDS process by providing accurate and timely information on clinical assessments, Resident Assessment Protocols (RAPs) and care planning, regulatory requirements, reimbursement, quality indicators (QIs) and quality measures (QMs), automation and transmission of federally managed instruments, and research. AANAC provides opportunities for basic and advanced RAI/MDS education and is a strong voice for clinicians in the policy and legislative arena. In the first paragraph of its welcome letter, AANAC states, “You have joined a powerful group of nurses and other healthcare professionals committed to getting their questions answered on the MDS and the Prospective Payment System (PPS).” Its philosophy is to become powerful advocates for resident care and resident rights, forming a group that can come together and share information and raise issues that are important to the long-term care population.
       On its website, AANAC points out how it can help caregivers meet the challenges of:
• Increasingly complex and new regulation
• Expanded professional liability and job responsibilities
• Gaining easy access to accurate and consistent information
• Obtaining recognition of the resources necessary to provide high-quality care
• Achieving a strong clinical voice in the regulatory policy decision-making arena.
       AANAC is a young organization, beginning in 1999. It has more than 7,500 members from all disciplines. Besides nursing, it is open to all therapists, administrators, billing professionals, social workers, activities professionals, dietitians, and health information professionals. One can receive weekly online newsletters (featuring coding questions and answers and timely articles); receive hard-copy quarterly newsletters; join a discussion group; receive need-to-know information (featuring materials that can be immediately downloaded and incorporated into the day-to-day practice of clinicians); and research an online archive of the most frequently asked questions on in-services, forms, policies and procedures, and clinical protocols. Tools, such as International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes and searchable federal survey tags, are also available.
       Every year in the fall and spring, AANAC holds national conferences that feature nationally recognized experts in clinical assessment and care planning who speak on the most up-to-date and current information related to the MDS process. Attendees can take a 3-day credentialing program as a pre-conference offering, and they have an opportunity to network with peers from across the nation.
       There are exhibits on technology, services, and products currently available as well as a peer-recognition awards luncheon. And, it was recently announced, AANAC’s educational program is moving from a credentialing program to a 2-year renewable certification program, effective January 2007. Would it not be helpful for all resident assessment coordinators (RACs) to be certified?
       Answers to questions that come from the discussion group are reviewed for accuracy by the national advisory panel. If you post a question to the Case Mix Discussion Group (CMDG), you may receive as many as 700 answers. Questions from the skilled nursing facility (SNF) MDS/PPS discussion group are selected by the clinical editor, sent out for review by a national advisory panel, and subsequently posted in “NAC News” weekly. Visit AANAC online at www.aanac.org.
       I recently had the opportunity to interview Diane Carter, CEO and president of AANAC, about her work with the organization. My questions and her answers follow.

Questions and Answers

       Question: What is your role in AANAC as president and CEO?
       Answer: My activities with AANAC include ensuring that: healthcare professionals involved in the RAI process are competent as a result of the educational and professional resources AANAC provides; the legal, regulatory, and public policy environment is favorable for healthcare professionals involved in the RAI process; and AANAC is recognized as the foremost source of knowledge about federally mandated assessment instruments. I am currently on the Technical Expert Panel, which is working on the development of the MDS 3.0, and I am involved in other regulatory and policy issues that affect the role of RACs and other professionals involved in the RAI/MDS process.
       Question: How has AANAC grown?
       Answer: Founded in 1999, AANAC has grown at an annual rate of approximately 1,000 members per year for a total of 7,500 members in 2006. This growth is largely the result of recognition of the importance of having educational materials that are written by teams of writers and reviewers and not single consultants or individuals. As we all recognize, regulations are subject to interpretation; therein lies the importance of review by a large number of experts in the field. This is what AANAC is best at and seeks to achieve through our materials development process. In addition, there is no other association or organization developed by nurses for nurses and other clinicians. As a nonprofit, our resources and funding go right back into developing more resources that clinicians request to support their own professional development. I believe that another contributing factor to our growth is that the role of the RAC is finally receiving the stature it deserves. Corporations are partnering with AANAC to support and train their clinicians in order to provide better outcomes for their residents, receive the reimbursement they are entitled to, and demonstrate improved resident outcomes.
       Question: How do you build the national advisory panel? Who are its members?
       Answer: Our national advisory board is made up of professional clinicians who have worked in this field for many years in a number of roles related to the RAI/MDS process. We have criteria which must be met to join this group of elite professionals, including the number of years they have worked with the RAI/MDS process, completion of their RAC certification (RAC-C), completion of an extremely difficult oral exam proctored by 2 certified master teachers, and demonstration through their resume and references of their public speaking ability as well as ability to answer RAI/MDS and Medicare questions accurately. Of the 15–20 master teachers who have completed this very challenging process, 8 of them, including our clinical editor, sit on our master teacher advisory board. The board works to ensure that all of our materials, including all of the courses we offer, are accurate and up to date. In addition, we have a process of advisory board turnover to ensure that our materials have the benefit of the best and brightest people in the field over time.
       Question: Is there a board of directors for this organization?
       Answer: We have a 9-person board of directors, and each director serves a term of 3 years. Therefore, 3 new directors are seated each year. Our board of directors is mission- and competency-based. What this means is that our board of directors selects the policy issues that will be priorities for the upcoming year(s) and then selects the competencies (which will drive the selection of new board members) that will support the policy priorities. For example, right now the priorities of the board are the development of electronic health records (EHRs), leveraging the role of the RAC to a care management role, encouraging clinicians to become more involved in the policy/legislative issues, and becoming more involved with the culture-change movement. Therefore, the competencies we will be seeking for next year include a person with a legislative background, a facility-based MDS coordinator, and a person who has a strong background in physical assessment, such as a geriatric nurse practitioner (GNP) or a person with similar strength in clinical assessment.
       Question: How did you become involved in AANAC? Were you an MDS coordinator?
       Answer: I am the founder of AANAC and have worked with the MDS since its inception. I began my career as a Director of Nursing (DON) in a local nursing home in Denver, Colorado. My background with MDS includes working with the researchers who developed the tool including Sue Nonemaker, Katherine Hawes, John Morris, and Brant Fries. I was also fortunate to work with David Zimmerman on the development of the QIs. I was the state MDS Coordinator for Colorado and worked on the beta test to implement transmission of the MDS to the Colorado State agency. I taught more than 400 educational programs for providers and surveyors on a number of regulatory issues including the MDS. In 1998, I, like most trainers, was teaching on MDS and PPS implementation and transmission when a friend showed me a website and listserve and said, “these people need an association that supports their activities and you are nurse; why don’t you form an association?” I thought it was such a good idea that I quit my job the following Monday morning, and here we are with 7,500 members and the best educational program in the country. I wish I could take credit for our program and all the great compliments I receive for it, but as I say it was developed by so many of the best minds in the country that I cannot help but give them all the credit they deserve. I am so grateful and feel so fortunate to have had the opportunity to work with so many talented and smart people.
       Question: Given all the opportunities for education in AANAC, would you like every RAC to become certified?
       Answer: We would love to see all clinicians involved in this process become certified with their RAC-C. We believe that clinicians face much vulnerability when they hold this position, with little or no formal education in this completion of this increasingly complicated instrument/process. We also believe that facilities that do not have a qualified RAC-C are in a dangerous position. Since this tool drives resident care, reimbursement, regulatory oversight, and consumer reporting, the administrator of a building cannot afford to have an NAC who is not extremely competent in this process. As we say, do the Medicare math; one must realize that one activities of daily living (ADL) error can result in: RUX $564.83 minus RUL $495.04, which equals $68.79 per day times 45 assessments per month times 30 days—equaling $92,866 each month in lost revenue.
       Question: Can we use information from AANAC during a survey? Is the information honored by state and federal surveyors?
       Answer: We receive questions daily on our discussion group from nurses in the middle of their state survey. This is because clinicians know that the information they receive is reliable, accurate, and timely or they would not use this discussion group as an invaluable, quick, and reliable resource.
       Question: Is there anything else you would like to say?
       Answer: Our focus at AANAC has been and continues to be to support clinicians by getting them the most current information and accurate answers to their questions quickly, so as little nursing time as possible is lost clarifying coding conventions on the MDS. Nursing time is much too valuable to have it diffused and diverted away from resident care. American nursing home residents deserve the best nursing care available, and we at AANAC hope to contribute by giving nurses time to care.

       If you have a question you would like to see addressed and/or an idea for a future “MDS” article, e-mail it to ryand@hmpcommunications.com.