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Preparing for OASIS-E: Health Literacy

    In the last few years, health equity has been receiving a lot of attention from the government. Medicare-certified home health agencies will be contributing data to the Centers for Medicare & Medicaid Services (CMS) by 2023 with new OASIS-E items that are “social determinants of health (SDoH).”

    These SDoH items will shed light on how individual and community inconsistencies concerning living conditions, food security, healthcare access, employment, and education affect the quality of care.

    The following are components of SDoH:

    • Ethnicity (specifically asking about Hispanic, Latino/a, or Spanish origin)
    • Race
    • Preferred language (including need or want of an interpreter)
    • Transportation
    • Health literacy
    • Social isolation

    About B1300 Health Literacy

    As one of the most critical components of SDoH, health literacy, when low, can lead to negative health outcomes and higher medical costs, among others. However, this is not just limited to poor reading skills because the opposite does not automatically mean comprehension as well. 

    Health literacy is defined as the ability to understand basic health information and services, make sound healthcare decisions, and access and navigate the healthcare system, which can be complex. There are so many medical decisions to make, ranging from simple to complicated ones like insurance, preventative care, medication and disease management, and even appointment follow-ups with multiple specialists.

    Gathering Health Literacy Data

    Delivering the Health Literacy Question

    Patients tend to be defensive or shy when they are questioned about their health literacy. Make sure to acknowledge their reservations and let them know that knowing all about healthcare is not a walk in the park. It is a good warm-up before asking the B1300 question. Effective strategies are:

    • Focus on “need-to-do” and “need-to-know” questions.
    • Ask them to repeat your instructions in their own words.
    • Use images.
    • Use simple English that is easy to translate.

    Using Z Codes

    Providing accurate SDoH-related Z codes, which range from Z55 to Z65, can most definitely improve outcomes on all fronts, including identifying risk factors and making appropriate referrals. SDoH data can be gathered from the patient and/or their family, home health clinicians, social workers, or providers. Coders can then assign SDoH Z codes based on the documented self-reported data and/or information in a patient’s record by any of the care team members.

    How to Improve Health Literacy and Outcomes

    The first step to improving health literacy is by delivering care as if everyone has limited literacy. Break down the barriers surrounding it and remove the stigma by including it as a basic service. Here are more practical tips that are focused on inclusivity and empathy, which are vital to improving health literacy:

    • Provide spoken and written instructions in languages understood by your patients. Include information in your patients’ languages other than English.  
    • Make sure your materials can be easily understood by all users. 
    • Consider the sight- and hearing-impaired by creating large print materials, braille materials, sign language interpreters, and telephony.

    Covering All Bases

    Agencies should start educating their clinicians now on these health equity gaps and assessing their patient population to determine the specific needs of individual clients. If this feels overwhelming, take small steps to make progress. Look at each SDoH OASIS-E item separately and consider the interventions or pathways that will achieve the best outcome and meet the patient’s needs.

    Make sure your QA team or provider is also preparing for the new items, as well as the latest changes in the OASIS documentation. QA and coding will play a significant role in maintaining your OASIS accuracy and supporting your clinicians in learning how to document the new assessment items properly. Furthermore, documentation accuracy will not only help your agency stay compliant and ensure effective healthcare services but also help you take advantage of incentives and opportunities for business success in the new value-based era.