OASIS Alert

Not asking the right questions can cost you, so follow these 8 tips for success.

If you think a discharge OASIS assessment is just a formality, watch out - half-baked discharge assessments can lead to PEPs and adverse events.

One of the most important uses for OASIS data is outcome reporting, as the recent expansion of the Home Health Compare Web site makes clear (see OASIS Alert, Vol. 4, No. 10, p. 96). Outcome reports measure change during the episode, and results depend on the accuracy of the underlying OASIS answers, explains OASIS expert Linda Krulish with Redmond, WA-based Home Therapy Services.

Further, the accuracy of adverse event reports - so central to the new survey process - also depends on the quality of the information entered into the OASIS assessments, warned consultant Marion Donahue with Simione Consultants in Hamden, CT, during a recent teleconference sponsored by Eli.

When searching for problem areas, most agencies immediately look to the start of care assessment. But the discharge assessment is just as important, and is more likely to be inaccurate, Donahue said.

Agencies focus primarily on the start of care assessment because it establishes the baseline and determines the plan of care and the case mix for the episode, Krulish acknowledges. Many agencies use a special admissions nurse who is the clinician best trained in OASIS assessment. "But they'll send anyone to do the discharge assessment," she notes, whether the person has solid OASIS assessment skills or not.

Clinicians also may need to complete discharge assessments without an accompanying visit if the patient is unexpectedly discharged (for example, if the patient dies, moves away or refuses to let you come back), observes consultant Pat Sevast with American Express Tax & Business Services inTimonium, MD.

If this happens, accurate and complete visit notes will be important, since whichever clinician made the last visit will need to do the discharge OASIS assessment based on the initial assessment plus more current information from recent visits, she explains.

Agencies searching for ways to improve outcomes should focus on what they can control, Donahue advised, with accuracy of data and consistency of assessments heading the list. To improve your discharge OASIS assessments, experts tell agencies to:

1. Reframe the event. The discharge OASIS is a clinical process, not just an administrative task. It asks, "Is this person ready to be discharged?" Avoid viewing the discharge as a "done deal" and the OASIS as the paperwork required to process it, Krulish warns. You could be creating an unnecessary partial episode payment (PEP) adjustment if you discharge a patient who isn't ready and have to readmit within the 60-day episode, she explains.

2. Train all clinicians. Consistency is key to data accuracy, experts say. If the person doing a discharge OASIS rarely completes OASIS assessments, but an expert clinician handles the admission, you're likely to have problems with outcome reports, Krulish says. The less experienced person is less likely to answer accurately. It will be hard to tell if changes are due to patient changes or changes in who does the assessment.

3. Be comprehensive. Because problems resolve throughout an episode, clinicians often look closely at fewer and fewer items until they're down to just one issue. When that is resolved, they assume they're done, Krulish says. But conditions of participation require a comprehensive assessment on discharge, with the same scope as at start of care or recertification, she emphasizes. You need to evaluate cognitive status, medications, wound status and all the other components of a full assessment.

4. Look at medication management. It's fairly common for problems with medication compliance to arise several weeks into the episode, and the patient may not bring it up, Krulish says. The patient's sense of urgency may diminish. Perhaps he thinks the infection is gone or he doesn't want to take the diuretic because he has to get up to the bathroom at night. Often a therapist will be the last clinician to see the patient, but she still needs to assess compliance with taking medication.

5. Look for new problems. As a patient changes throughout the episode, you should modify the treatment plan. But agencies often overlook this step, Krulish says.

Then at discharge the patient may not be seeing all of the disciplines because there wasn't a problem earlier. Maybe the patient has reached the therapy level that was the goal, but now has a pressure ulcer or is noncompliant with medications.

6. Document caregiver presence. At discharge a patient may still need help with wound care, toileting, medication management or behavior problems. If the patient ordinarily lives alone, but a family member or other caregiver will live with the patient temporarily, be sure to note that, says Krulish. If not, you could end up with an adverse event, or even worse, the appearance that you abandoned the patient.

7. Don't assume. The better you know the patient, the more likely you are to think you know the answers to the assessment questions. But you shouldn't make that assumption. Perhaps the discharge plan will no longer work because transportation help is no longer available or a treatment location has fallen through. Or perhaps the patient has become incontinent, but hasn't mentioned it to the clinician.

Staff is less likely to evaluate something that hasn't been a problem for this patient before. So the items most likely to be missed on discharge are problems that have not been addressed during the episode, Krulish warns. Go through all questions and observe and assess, don't assume, she recommends.

8. Analyze the data. Don't wait for the outcome reports to check your data. Make a side-by-side comparison of OASIS data from the start of care and discharge assessments and look for problems, recommends Marion Donahue of Hamden, CT-based Simione Consultants .