OASIS Alert

Published on Sun Dec 05, 2004 PDF

Taking a few steps doesn't equal ambulation.

Misunderstanding M0700 (ambulation) can cost you, resulting in lower reimbursement and poor outcomes.
 
There are enough OASIS challenges to make your head spin. So sometimes you should go back to basics and be sure all your clinicians understand a question the same way. If you haven't focused on M0700 for a while, here's your chance.
 
M0700 asks clinicians to assess a patient's ability to safely walk (once in a standing position) or use a wheelchair (once in a seated position) on a variety of surfaces.
 
Clinicians have five options for describing the patient's current ambulation ability. These range from "0" - "Able to independently walk on even and uneven surfaces and climb stairs with or without railings (i.e., needs no human assistance or assistive device)" - to "5" - "Bedfast, unable to ambulate or be up in a chair."
 
This M0 item can bump the patient's functional score up a level on the Home Health Resource Group and increase an episode reimbursement by several hundred dollars. M0700 is also the basis for your agency's results in the Home Health Compare measure "Patients who get better at walking or moving around."

Reality: When Outcome-Based Qual-ity Improvement scoring translates M0700 answers into outcome measures, it doesn't always capture improvement in ambulation, experts warn. For example, if on admission a patient can walk from her bed to the chair using a cane, she scores "1" (Requires use of a device [e.g., cane or walker] to walk alone or requires human supervision or assistance to negotiate stairs or steps or uneven surfaces). She'll still score "1" on discharge if she needs the cane but can walk all over the house. Even though her ambulation has improved, that progress won't show up on your outcomes.
 
On the other hand, if on admission she was bedfast (5) and on discharge she ambulates independently (0), the vast improvement looks the same on your outcomes as if she improved from bedfast (5) to chairfast (4), experts explain.

Don't overlook: The emphasis in M0700 is on the word safely. The clinician shouldn't ask whether the patient can walk, but whether she can walk safely, says OASIS expert Linda Krulish with Redmond, WA-based Home Therapy Services. This consideration includes both physical and cognitive ability.
 
Does she hold onto furniture and walls to get around? Does she understand the need to take her time on the stairs? Is the environment safe for ambulation? Are medications making her dizzy? Clinicians who don't focus on safety tend to overestimate the patient's ability, Krulish warns.
 
"Nurses tend to score this item on a macro level - can the patient ambulate or not - while therapists generally take the safety factor into consideration," reports clinical consultant Judy Adams with Charlotte, NC-based LarsonAllen Health Care Group.

Tip: One frequent error is an OASIS evaluation that scores the patient "1" on M0700, but where notes show the patient is actually a "2" (Able to walk only with the supervision or assistance of another person at all times), Adams says.

Underscoring negatively affects outcomes: Unless clinicians understand the need to evaluate how much assistance the patient requires, they may underscore the patient and leave less room for improvement.