Home Health & Hospice Week

Check out new OASIS-E Guidance Manual.

You now have more educational tools for one of the big changes hitting on Jan. 1.

The Centers for Medicare & Medicaid Services has issued the Draft OASIS-E Guidance Manual, as well as an updated version of the OASIS-E tool itself. The updated tool contains minor revisions from the OASIS-E draft CMS published in February.

For example: In M0040, CMS added missing boxes to enter the patient’s last name, the agency notes in a summary chart of the updates.

There are more substantive changes too, including removing E, F, G, and H from the Follow-up and All Items time points for GG130 (Self-Care) and removing G, K, O and S from the Follow-up and All Items time points for GG170 (Mobility).

OASIS has been important for home health agencies since its inception, on both payment and quality fronts. “The pursuit of accuracy in data collection has consumed enormous amounts of limited agency resources (time and money),” notes consulting firm Kornetti and Krafft in online analysis. “Achieving a level of mastery, then sustaining those competencies, is not an easy task,” the firm acknowledges.

The importance of OASIS will only grow under the Value-Based Purchasing payment model, points out consultant Melinda Gaboury with Healthcare Provider Solutions in Nashville. “The OASIS items that are included in [VBP] include the Dyspnea question M1400, Discharge to Community M2420, [and] Improvement in Management of Oral Meds M2020,” Gaboury explains in a video blog. “And then we have two Total Normalized Composite Change scores in Self-Care and Mobility,” Gaboury continues. The Mobility TNC includes three items — M1840, M1850, and M1860 — and the Change in Self-Care TNC is comprised of six items — M1800, M1810, M1820, M1830, M1845 and M1870, she reviews.

“These specific OASIS items will have” a “huge impact” under VBP, Gaboury emphasizes. OASIS “impacts everything,” she says — outcomes, star ratings, reimbursement levels/ HIPPS codes, and — starting in January — your VBP results and payment adjustments.

“Diligence with OASIS is absolutely necessary,” Gaboury stresses. “The reality of OASIS-E … becoming a factor in January 2023 just makes the intensity of your OASIS edu­cation … more important as we begin to move through the remaining months of 2022 to prepare for 2023,” she says.

“Knowledge application, a clear understanding of item intent, and score interpretation based on current guidance is critical,” Kornetti & Krafft advises. “Once data is collected, integrating the information into the plan of care and the focus of every visit is necessary for consistent measurable outcome improvement,” the firm says.

HHAs will see a number of big changes when switching from OASIS-D1 to OASIS-E, including the addition of cognitive function assessment items, social determinants of health (SDoH) items, and more. (See HCW by AAPC, Vol. XXXI, No. 7, for a full list of items added.)

The ratio of M items will drop even further in OASIS-E. “You will now find sections in the data set representing letters A through Q,” explains consulting firm McBee in online analysis. “Within these sections you will find many new assessment items beginning with those letters, as well as our current OASIS-D1 items divided under new sections,” the firm says on its blog.

With added items comes added burden. Once staff become familiar with the new BIMS, CAM, and PHQ9 assessments, CMS expects OASIS completion time to “take an additional 7.5 minutes to complete for just these 3 items,” McBee highlights.

Given the big changes in OASIS-E, “the time to start preparing and educating staff is now,” McBee urges.

Tip #1: “Encourage staff to share real-life cases to talk through during meetings and as they are happening,” McBee recommends. “Holding a discussion on scenarios or challenges one clinician encounters may assist others in understanding the application of OASIS-E guidance.”

Tip #2: Assess clinicians’ OASIS performance right away. “Monitor documentation to ensure accuracy and consistency,” McBee urges. “Quick turnaround of feedback reduces and prevents continued errors and the formation of habits.”

The new form and manual are technically still drafts, with Office of Management and Budget approval expected later this year. But experts predict no major changes will be forthcoming.

Note: A link to the 356-page manual is at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/HHQIOASISUserManual and links to the updated OASIS-E instrument and change chart are at https://edit.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/OASIS-Data-Sets.