Home Health & Hospice Week

You may think you don't need to worry about OASIS C's focus on seasonal flu and pneumonia vaccines -- but you could easily prevent later mistakes by preparing for the big change now.

Eli's experts offer you this advice to set you on the right course.

OASIS C, which takes effect Jan. 1, 2010,asks agencies to respond to a dozen new process meas ures, including vaccination rates. But don't wait until January to start, says expert Ann Rambusch with Rambusch3 Consulting in Round Rock, Texas. It's not too early to prepare for the big change, she says.

M1040 (Influenza vaccine) asks if the patient received an influenza vaccine from your agency for the current year's flu season, during this episode of care. Your answer choices are "No," "Yes," and "NA Does not apply because entire episode of care (SOC/ROC to Transfer/DC) is outside this influenza season." For this OASIS question, CMS designates the influenza season as Oct. 1 through March 31.

Problem: The clinician answers this question at either transfer or discharge, but the agency must collect this information at the start of the episode so the patient can be immunized if needed, says consultant Judy Adams with Adams Home Care Consulting in Chapel Hill, N.C. You need to identify if and when the patient received the vaccine. If the patient did not, you need to know if the patient is eligible for the vaccine, Adams explained to participants in a recent Eli-sponsored audioconference, "Home Health Boot Camp for New OASIS C Process Measures, Part 1".

Strategy: One tool could be to add this question to a letter you send to the patient's primary physician, along with other questions you may have about the patient's history. If the patient has not had the vaccine, you'll need to know if the doctor wants the agency to provide it. You'll need an order as well, Adams explained.

Another idea is to add this question to the intake information so you have as much information as possible right away. Putting this information in an Excel spreadsheet would give you a record to consult now and later if the patient is ever readmitted, Adams suggested.

How to do it: For an example of a spread sheet to track immunizations, go to www.qualitynet.org/dcs/ContentServer?c=MQTools&pagename=Medqic%2FMQTools%2FToolTemplate&cid=1200602383195. Select "Patient/Staff Tracking Record" in the right-hand column.

Helpful: For education materials in Spanish and English, check out "Vaccines and immunizations" on the CDC Web site.

OASIS C item M1045 asks why the patient did not receive the influenza vaccine during this episode of care. There are many possible reasons that won't get you in trouble. For example, the patient may have already received the flu vaccine, there may be a medical contraindication, the patient may refuse it, or you may have administered it during a previous episode.

The CDC recommends the pneumococcal polysaccharide vaccine (PPV) for all adults 65 years and older, as well as for younger patients who have a variety of health problems. Usually only one vaccination is necessary, but a patient who received the PPV before the age of 65 should receive a second dose after 65, as long as five years have elapsed since the previous dose.

Because the PPV is not administered again every year, patients and staff may have a harder time keeping track of this vaccine than they do with the flu vaccine, experts say.

If the agency did not provide the PPV during the current episode, M1055 asks why. Again, providers could have appropriate reasons why this would be the case, Adams said. The patient may have already had the PPV, may not have wanted it, or may have had contraindications.

Resources: For information on CMS' expectations and reimbursement for vaccines, go to www.cms.hhs.gov/AdultImmunizations/02_Providerresources.asp. For information about preparing your agency for a flu pandemic, go to www.flu.gov/professional/hospital/homehealth.html.