Do your OASIS scores add up to what’s really going on?

OASIS Scores Add UpEditor’s note: This article originally appeared in the July 25 issue of The Monday Fix, a free weekly email from Home Health Solutions featuring home health coding and OASIS tips.  Click here to subscribe.

In the complex world of home health, where boundaries and guideposts are almost constantly revised and re-interpreted, an agency’s success may well revolve around one crucial skill: the ability to accurately use the data collection tool known as OASIS.
The Outcome and Assessment Information Set (OASIS) is emerging as a critical performance measure for the field in general and for individual agencies.
“It’s hard to overestimate the importance of this data set,” says J’non Griffin, owner of Home Health Solutions LLC. The OASIS affects patient outcomes, reimbursement, STAR ratings, Value Based Purchasing and an agency’s bottom line.
And that’s just in its existing form.
Come Jan. 1, OASIS will ratchet things up a notch. The Centers for Medicare and Medicaid Services (CMS) implements a revised version of OASIS on the first day of 2017, and the new version known as OASIS C-2 will feature the first quality measures from the Impact Act of 2014.
This Act established some standardized measures for easier reporting and sharing of data between skilled nursing facilities, long-term care hospitals, inpatient rehabilitation facilities and home health. The goal is to facilitate coordinated care and improve patient outcomes, providing better post-acute care for Medicare beneficiaries.
Among other data, C-2 items will capture standardized reports of skin integrity, a patient’s functional status and cognitive function, medication reconciliation, incidence of major falls, transfer of health information and care preferences during a patient’s transition from one facility to another.
This is important information for the home health field, J’non says.      “The overall goal is to collect data necessary to create a vital picture of what’s actually going on in home health care,” she says.
Agencies are tasked with the same goal on an individual level as they complete the OASIS for each patient. But that goal can easily be hindered by hurrying through the process, looking at it as simply additional forms to be filled out, or – perhaps most damaging — limiting its scope by failing to understand the nature and reach of the information it seeks to collect.

The big picture from the details

Accuracy in reporting is requisite for proper use of OASIS to collect necessary information, yet many clinicians struggle to correctly capture  the information.
It’s quicker and easier to create a superficial account, relying on a cursory overview or a patient’s information alone.  But that can be misleading, and J’non believes agencies must train their clinicians to look at how all the information about a patient works together to create a cohesive report.
In some cases, clinicians must look beyond the narrow focus of the question at hand to consider other circumstances which may affect the answer, and carefully weigh what a patient tells them against the realities of a diagnosis by the physician, risk assessments, environmental evidence and more.
Sheena Meeker, a quality review mentor on the HHS team, offers the following example of how it may be necessary to carefully consider all aspects of a patient’s circumstances to make sure OASIS scores add up to a true reflection of what is going on.

EXAMPLE:
Your patient is a 92-year-old male who lives alone in a single-story family home. His daughter assists with some errands, and occasionally meals at home. When you assess your patient’s ambulation status, you note the patient is a high fall risk, and uses walls and furniture to navigate through his home. He has a 2-handed walker in the home which he states he uses more than half the time for ambulation.  His medications are located on the kitchen counter, and he spends more than half his time in the living room. The patient states there is no problem with remembering to take his medications and he does not need any help. You are able to confirm this with his daughter.

How would you score M1860?

a. (0) -Able to independently walk on even and uneven surfaces and negotiate stairs with or without railings (i.e., needs no human assistance or assistive device)

b. (1) -With the use of a one-handed device (e.g. cane, single crutch, hemi-walker), able to independently walk on even and uneven surfaces and negotiate stairs with or without railings.

c. (2) -Requires use of a two-handed device (e.g., walker or crutches) to walk alone on a level surface and/or requires human supervision or assistance to negotiate stairs or steps or uneven surfaces.

d. (3) – Able to walk only with the supervision or assistance of another person at all times.

ANSWER: d  
RATIONALE: Even though the patient uses a walker more than half the time, safe ambulation for this patient requires at least supervision due to a high fall risk score. Safety of the patient is the key consideration in this case, and the high fall risk score directly impacts the correct response here.

How would you answer M2020?

a. (3) Unable to take medication unless administered by another person.

b. (1) Able to take medication(s) at the correct times if:(a) individual dosages are prepared in advance by another person; OR (b) another person develops a drug diary or chart

c. (0) Able to independently take the correct oral medication(s) and proper dosage(s) at the correct times.

d. (2) Able to take medication(s) at the correct times if given reminders by another person at the appropriate times

ANSWER: a
RATIONALE: Since the patient spends the majority of his time in the living room and his meds are in the kitchen – AND he requires assist or supervision for safety with ambulation – this would require someone to assist with medications for safety. The patient’s safety is again the key consideration, and impacts the correct answer.
This example illustrates how easy it can be for inexperienced, untrained and/or rushed clinicians to inadvertently mark the wrong answers on M1860 and/or M2020. The best protection against these kinds of accuracy errors is ongoing training, according to J’non.

What is your agency doing to prepare?   

Smart home health agencies are gearing up for the implementation of C-2 by using the next few months to carefully review how well their clinicians are using OASIS, and provide the training needed to shore up weaknesses, J’non says.
Who should agencies target for OASIS C-2 training?
“Everyone,” J’non says.
She is currently finishing up a brand new recording from HHS offering C-2 training, and will make it available via the HHS online store in the next few days.
In today’s fluid home care climate, where regulations and requirements shift rapidly and the only thing certain is the likelihood of more change soon, J’non  says agencies can’t afford to look at training as “over and done.”
Being serious about providing excellent care means getting serious about providing ongoing training and support to clinicians.

Click here to browse the HHS online store to see which online courses are available to help your agency. 

Home health agencies brace for next 6 months

Main art July SolutionsWith six months of adjustment to the 68,000 new health codes known collectively as ICD-10-CM now under its belt, the home health industry is buckling up for Round 2: six more months of new codes to assimilate, code revisions to integrate and new pre-claim reviews to handle.

More than 2,500 changes to the ICD-10-CM classification set are expected to be implemented Oct. 1: at least 1900 new codes, some 350 revised codes and more than 300 deleted codes.  The Tabular List will change, some Excludes Notes will shift and others will disappear completely in this first reworking of the code set since its implementation at the first of this year.

While home health adapts to this newest version of the new classification set, agencies in at least 5 states will also grapple with rollouts of new pre-claim reviews changing the way they process claims for services.  The Centers for Medicare and Medicaid Services (CMS) will require agencies in the affected states to secure prior authorization before processing claims.

Home health agencies in other states, expecting to soon be under the same requirement,  will pay close attention to next month’s initial rollout in Illinois, as well as similar implementations in Florida on Oct. 1, Texas on Dec. 1, and both Michigan and Massachusetts on Jan. 1.

Don’t even think about muttering a “whew” under your breath — at least not yet. There won’t be any rest for the weary at the end of these next six months.

In fact, what’s in store next could possibly have one of the largest impacts yet on home health.

THE IMPACT OF OASIS C-2

It’s hard to overestimate the importance of the Outcome and Assessment Information Set, the CMS data collection tool known by the acronym OASIS, to a home health agency’s operation. This intake of information can affect patient outcomes, reimbursement, STAR ratings, Value Based Purchasing and an agency’s bottom line.

And it’s about to become even more important.

The revised version known as OASIS C-2 becomes effective on Jan. 1, 2017, ratcheting things up a few notches with the implementation of the first quality measures from the Impact Act of 2014. This Act establishes some standardized measures for easier reporting and sharing of data between skilled nursing facilities, long-term care hospitals, inpatient rehabilitation facilities and home health.  The goal is to facilitate coordinated care and improve patient outcomes, providing better post-acute care for Medicare beneficiaries.

Some OASIS C-2 items, for example, are designed to help capture standardized reports of skin integrity, a patient’s functional status and cognitive function, medication reconciliation, incidence of major falls, transfer of health information and care preferences during a patient’s transition from one facility to another.

“As integral as OASIS has become to the success of home health agencies, it is only going to become more crucial in the future,” says J’non Griffin, owner of Home Health Solutions LLC.  “Moving forward with the Impact Act initiatives in a value based environment, inaccuracy in OASIS reporting will cost agencies not only valuable dollars but also referrals. Providers will only want to partner with agencies that have excellent outcomes.”

In the five states selected for pre-claim review, OASIS C-2 will be one of a triad of components integral to set up patient eligibility and establish medical necessity.  OASIS C-2 data will be used along with the patient’s comprehensive assessment and supporting documentation from the care provider to demonstrate why home health is necessary and support the pre- claim.

Home Health Solutions is offering assistance to agencies in the five initial states for reviewing and submitting those claims, and will expand the services to other states as needed. One of the first efforts the  HHS team undertakes when working with agencies on their pre-claim reviews  is stressing the importance of accurate OASIS completion.

Successful home health agencies, according to J’non, will be those who understand how crucial it is to collect OASIS information accurately, maintain effective and ongoing staff training and review to ensure continuity and efficient adaptation to changes, and develop a reliable system to bridge potential glitches such as those caused during periods of staff turnover.

Every employee needs training, every employee’s understanding of the material needs to be reviewed and every employee’s training needs to be updated regularly in order to maintain quality expectations.

“Because of the complexity and the frequency of changes not only in regulations but in the caregiver turnover in agencies, OASIS training is a continual education process,” J’non says. “Success can’t be achieved with a ‘one-and-done’ type training with clinicians.”

A LOOK AT C-2 CHANGES

The new version of OASIS will add several new items, including a GG-Functional section, and modify how some items are worded or numbered. Five items are revised and clarification is provided with regard to many of the questions submitted to the OASIS Help Desk.  “In addition, there are some major wound guideline changes that could mean a significant decrease in case mix points,” J’non says.

Perhaps the most surprising change for many clinicians has been a startling change in how pressure ulcers are to be reported under OASIS C-2, but there are numerous other changes that will require clinicians to undergo a thorough training session in order to best adapt, J’non says.

She is putting the finishing touches on an all new online training session for OASIS C-2 which, while not yet available for purchase at the time of this post, is expected to be uploaded to the Home Health Solutions LLC Online Store within the next week to 10 days.

Browse all the products on our  online store at:
The HHS Online Store