The Centers for Medicare & Medicaid Services (CMS) has recently published a new set of quarterly OASIS Q&As. It includes questions received by the CMS help desks from the first quarter of this year, following the implementation of the new OASIS-E. These Q&As offer valuable guidance on addressing specific OASIS-E questions in complex situations, clarifying the inclusion of new OASIS items in risk models, and the latest exclusions from quality reporting.

We have selected some Q&As from the set that we believe to be the most helpful.

New Risk Models

Question: Are the new items that were added to the OASIS-E instrument being used in the new risk models that took effect 1/1/2023?

Answer: To include new items in risk models, CMS first needs to analyze the data submitted for those items. As data collection for OASIS-E began January 1, 2023, the items new to OASIS-E are not used in these new risk models but will be evaluated and considered for use in future risk models. However, as CMS was able to map responses available from OASIS-E item D0150 – Patient Mood Interview (PHQ-2 to 9) to the responses available from OASIS-D1 item M1730 – Depression Screening, D0150 is used in the new risk models that took effect January 1, 2023.

Quality Reporting Exclusion

Question: What assessment-based quality measures exclude patients who are transferred or discharged from home health to hospice?

Answer: Patients who were transferred to an inpatient hospice or discharged to a non-institutional hospice (on or after January 1, 2023) are excluded from the calculation of the following OASIS-based quality measures: 

• Improvement in Ambulation/Locomotion
• Improvement in Bathing
• Improvement in Bed Transferring
• Improvement in Toilet Transferring
• Improvement in Lower Body Dressing
• Improvement in Upper Body Dressing
• Improvement in Management of Oral Medications
• Improvement in Bowel Incontinence
• Improvement in Confusion Frequency 
• Improvement in Dyspnea
• Discharged to Community

These hospice exclusions apply to quality episodes with a M0906 Discharge/Transfer/Death Date of 1/1/2023 or later:

1. That end in a transfer to an inpatient hospice (M0100 Reason for assessment – RFA 6 or 7 Transferred), and M2410 – Inpatient Facility response is 4 – Hospice, OR
2. That end in a discharge to a non-institutional (home) hospice (M0100 Reason for assessment – RFA 9 Discharge from Agency), and M2420 – Discharge Disposition is response 3 – Patient transferred to a non-institutional hospice.

D0150

Question: Please clarify when the entire Patient Mood Interview should be completed for D0150 – Patient Mood Interview (PHQ-2 to 9). The instruction in the OASIS-E Guidance Manual appears to conflict with the language in the D0150 item.

Answer: At times CMS provides new or refined instruction that supersedes previously published guidance. In such cases, use the most recent guidance. Related to the Patient Mood Interview, please disregard the statement in the OASIS item that states “If either D0150A2 or D0150B2 is coded 2 or 3, CONTINUE asking the questions below. If not, END the PHQ interview”. This statement is outdated due to refinements in OASIS guidance.

Please use the instruction found in the Response-Specific Instructions for D0150 in the OASIS-E Guidance Manual, which reflects the most recent guidance. As stated in the manual, whether or not further evaluation of a patient’s mood is needed depends on the patient’s responses to the PHQ-2 (D0150A and D0150B). If both D0150A1 and D0150B1 are coded 9, OR, both D0150A2 and D0150B2 are coded 0 or 1, END the PHQ interview; otherwise continue. For all other scenarios proceed to ask the remaining seven questions (D0150C to D0150I) of the PHQ-9 and complete D0160, Total Severity Score.

N0415

Question: Please provide guidance on the following scenario. A patient is admitted to a home health agency and then, during the assessment timeframe, goes to the Emergency Department (ED) and receives a one-time dose of a medication that is classified as a medication in the list of high-risk medication for N0415 – High-Risk Drug Classes: Use and Indication. If the Start of Care assessment was not completed until after the patient returned from the ED should the medication that was received in the ED be considered when coding N0415?

Answer: The intent of N0415 – High-Risk Drug Classes: Use and Indication is to record whether the patient is taking any prescribed medications in the specified drug classes and whether the patientspecific indication was noted for all medications in the drug class.

Code any medication that is used by any route in any setting (e.g., at home, in a hospital emergency room, at physician office or clinic) while a patient of the home health agency that is also part of a patient’s current reconciled drug regimen, even if it was not taken at the time of assessment.

O0110

Question: We know that we code O0110 – Special Treatments, Procedures, and Programs based on what is part of the current care/treatment plan at the time of the assessment. Can CMS provide further clarification on how to code O0110O1 – IV Access and O0110O4 – IV Access; Central if a PICC line is being pulled during the discharge assessment?

Answer: The intent of O0110 – Special Treatments, Procedures, and Programs is to identify any special treatments, procedures, and programs that apply to the patient. Check all treatments, programs and procedures that are part of the patient’s current care/treatment plan at the time of assessment, even if not used during the time of assessment for SOC/ROC (or discharge). This includes a PICC line that is being discontinued at the time of the assessment

Enhancing OASIS Data

Completing the OASIS form can be challenging due to various factors that require a thorough analysis and understanding of a patient’s case. Reviewing the quarterly CMS Q&As can improve one’s ability to answer assessment items in the OASIS.

To help ensure OASIS accuracy, your QA team or provider must also be proficient in evaluating unique patient cases and identifying areas for improving OASIS item responses. This will further promote patient-centered care, improve outcomes, and optimize reimbursements.

Access the April 2023 OASIS Q&A here>
Access all CMS Quarterly OASIS Q&As here>

The post Eyes Here: April 2023 OASIS-E Q&As first appeared on Qavalo.

The new OASIS-E emphasizes assessing patients’ cognitive function. Section C provides detailed guidance for evaluating memory, communication skills, and decision-making. The manual also includes tools to identify delirium, such as the Brief Interview for Mental Status (BIMS), which assesses attention, recall, and orientation. This section can improve clinicians’ evaluation and care planning for patients with cognitive impairment.

What Is BIMS?

BIMS is a standardized tool that can provide valuable information to clinicians in evaluating patients for possible dementia diagnosis. While it cannot be used to make a diagnosis itself, BIMS can help determine whether a more in-depth evaluation by a physician is necessary. BIMS consists of five OASIS items that are used to evaluate the patient’s temporal orientation, ability to repeat words spoken by the clinician, and recall those words with or without cueing. BIMS scoring can also help identify social determinants of health risk factors and basic needs. The test is easily replicated, making the results more consistent with tests performed by other care providers.

Challenges of Completing Section C and BIMS

The cognitive function section of the OASIS-E poses challenges for clinicians in understanding the meaning behind the assessment items and using the information in other parts of the assessment to respond accurately. To improve scoring on this section, clinicians should consider other OASIS items that may affect the current cognitive state of a patient. Confusion and delirium, for instance, are frequently a symptom of a urinary tract infection. However, once the infection is cleared, the confusion resolves itself. Corrective action can lead to significantly better outcomes.

Additionally, many clinicians find the BIMS one of the most confusing and complex parts of the OASIS-E. Some clinicians opt not to perform the interview, indicating that patients cannot understand and therefore cannot participate in the interview. However, It is essential to figure out, for instance, why a patient has difficulty with language or speech, examine what is going on with the patient, and try to accommodate them for BIMS interview. Failing to do so may cause a disconnect between what is being documented on the assessment and what is being documented on the medical record, which could lead to problems for agencies come survey time. The challenge with the OASIS item may be due to inadequate training for clinicians. Administering the BIMS can be time-consuming, especially if the patient has difficulty understanding or answering the questions, hence, clinicians need to be trained on how to streamline this process without compromising the quality of the assessments.

Scoring Section C Items Accurately

To ensure accurate and complete scoring, clinicians responding to items regarding a patient’s cognitive status should involve caregivers or family members whenever possible. Patients may not remember or disclose information accurately, making it important to have additional perspectives. This is particularly crucial for C0100, “Should Brief Interview for Mental Status be Conducted?” If a caregiver or family member is unavailable, clinicians should take the full five days allotted by the Centers for Medicare and Medicaid Services (CMS) to complete the assessment and gather the necessary information.

Educating staff on the intent of the item and the potential impact of inaccurate responses on other assessment items is the most valuable strategy. However, the cognitive status section of the OASIS assessment is challenging, and clinicians must invest time and effort into learning how to use and score the screening tools required.

Promoting Patient-centric Care Through BIMS

BIMS is a simple cognitive screening tool that plays a critical role in detecting cognitive impairment in older adults, which is linked to the patient’s ability to self-manage their disease state and a higher rate of hospital readmission in Medicare patients. This underscores the importance of ensuring that patients with cognitive impairment have caregivers who can manage their disease state effectively.

The first item in Section C of the OASIS assessment determines whether a structured cognitive interview should be conducted using the BIMS tool. Conducting the BIMS assessment can help clinicians gain insight into the patient’s cognitive status, which may not be evident through observation alone. This information is vital for creating a comprehensive and valid plan of care and ensuring quality outcomes. As such, clinicians must be trained to understand the importance of using the BIMS tool accurately and reliably.

New OASIS-E Resources from CMS

CMS has added cue cards as a supplementary resource for providers to assist in conducting the BIMS, Patient Health Questionnaire (PHQ-2 to 9), and Pain Interview as referenced in the OASIS-E coding guidance. The OASIS-E Manual provides detailed instructions on how to use the cue cards and administer the BIMS. These cue cards are intended to provide a visual reference for the coding of response options.

The cue cards are available for download on the CMS Home Health Quality Reporting Training webpage.

Additionally, CMS has released a 5-minute video tutorial to assist providers in coding GG0170C, Lying to Sitting on Side of Bed, using simulated patient scenarios.

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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.

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In the face of the shifting home health landscape and in anticipation of the implementation of the OASIS-E and expanded Home Health Value-Based Purchasing (HHVBP) on January 1, 2023, home health agencies must focus on the best ways to prepare for it. The industry’s transition from OASIS-D1 to OASIS-E aims to better align with other post-acute providers’ data collection and care delivery to ultimately improve patient outcomes.

The shift to OASIS-E supports initiatives by the 2014 Improving Medicare Post-Acute Care Transformation Act. There are 6 new categories in OASIS-E that support the implementation of the standardized patient assessment data elements (SPADEs). OASIS-D1 already added two SPADEs elements, namely, GG: Functional Status and J: Incidence of Falls. While the OASIS-E data set has a different flow, there is a significant number of OASIS-D1 data elements that remain.

How to Prepare for OASIS-E

Here is how you can optimize your approach to preparing for OASIS-E:

1. Ensure OASIS-D1 competence

75% of the information in OASIS-E is already in OASIS-D1 thus, one of the best ways to prepare for the shift is to first ensure mastering the transitional aspects of OaASIS-D1 before proceeding to train for OASIS-E. Not only will this lay the foundation for making the implementation of OASIS-E easier, but it will also help improve agency outcomes on all fronts. Training too early for specific OASIS-E items may be in vain, as clinicians will not be putting them into practice for months. 

2. Evaluate your current processes using data

These are ways to do it:

• Identify the most common OASIS-D1 challenges.
• Have a QAPI program solely focused on improving outcomes.
• Evaluate OASIS comprehensive assessment forms by eliminating redundancy and ensuring the assessment is set for accurate coding and OASIS-E.
• Analyze OASIS and outcome reports to implement OASIS-D1 training based on clinicians’ current OASIS performance.
• Utilize technology and online resources for OASIS-E training.
• Leverage the support of your electronic health vendor in the implementation of OASIS-E and the timing of the updates.
  

3. Refresh your educational approach

There are many opportunities in the transition from OASIS-D1 to OASIS-E. One is for agencies to reevaluate their training programs and possibly redesign them more continuously to establish OASIS competence and confidence among clinicians. They must be encouraged to go beyond the surface of filling out the form and analyze the underlying data elements and their importance. This will ultimately affect employee engagement and retention positively.

4. Start preparation at a foundation level for OASIS-E now

Below is a list of how to go about it:

• Assess your agency’s operational efficiency.
• Establish electronic health record documentation best practices and use analytics to help with clinical decision-making.
• Perform OASIS baseline testing to identify gaps in knowledge.
• Perform objective OASIS competence measurements in the field and make sure your preceptors teach the same information.
• Train staff to help them stack skills and improve competence over time.
• Get the timing right by building OASIS-D1 competence now by including OASIS-E-specific data guidance throughout the second half of 2022.
• Leaders must familiarize themselves with the transitional relationship of the data elements between OASIS-D1 and OASIS-E. The rearrangement of sections and addition of new data elements might affect assessment techniques, which may require training on the Confusion Assessment Method and Brief Interview for Mental Status assessment.
• Get the ball rolling on initial education on the new OASIS-E-specific data elements, but not too early, as clinicians will need to retain the new information in 2023.

Ensure that your agency’s coding and OASIS review partners and processes are data-driven and focused on building performance insight.

Leverage Your OASIS QA Program

Redesigning your OASIS approach will improve efficiency as less time will be spent on improvements in your business and programs. However, this may take some time because it would be impossible for clinicians to get everything right with all the elements and factors involved in the documentation. Your QA program will greatly help ensure the accuracy of your documentation and optimize your reimbursements despite all the changes in the data sets and payment mechanisms. Make sure your QA team or provider is knowledgeable of new compliance standards to maintain quality and efficiency in your clinical back-office functions.

Accuracy and Timeliness Are Key

Assessment and OASIS data that are comprehensive and accurate are essential in demonstrating value-based performance in health care. Needless to say, if they are not, this may result in inefficiencies and errors, which may then snowball into ineffective care planning, incorrect billing, the loss of hard-earned revenue, and other more potentially serious patient care errors. Therefore, clinicians need to understand how OASIS has a substantial impact at the start, resumption, and discharge.

Riding the Tides of Change

Your efforts today in navigating the home health landscape are critical to your position and success in the competitive market moving forward, as home health is now more value-driven and the post-acute space becomes more collaborative. Realigning your perspective on OASIS training and excellence to your goals is a great way to move towards a positive performance trajectory in 2023.

The post Preparing for OASIS-E: A Step-By-Step Guide first appeared on Qavalo.

The Centers for Medicare & Medicaid Services (CMS) recently released the draft OASIS-E Guidance Manual, which provides guidelines for the 27 new items added to the OASIS-E Instrument that will be implemented on January 1, 2023.

An updated version of the draft OASIS-E Instrument was also posted, along with an outline of the revisions made from the previously posted version of the draft instrument. See links below

Gear Up Now

A survey released earlier this year revealed that 40% of agencies currently do not have an established plan for the OASIS E. Considering the implementation of the OASIS-E at the start of 2023 in line with the nationwide expansion of the Home Health Value-Based Purchasing (HHVBP) Model, there is no better time for home health agencies to prepare than now. It will give clinicians a good headstart to train for the new changes that will affect the entire OASIS structure.

All current revisions are consistent with the Improving Medicare Post-Acute Care Transformation (IMPACT) Act to promote interoperability between care settings. Interoperability will increase by having identical data assessment items as other settings because each setting uses the same criteria to complete the data set.

The data elements of the OASIS-E will help in addressing the needs of individual patients and will overall improve the execution of holistic care delivery.

Read more about OASIS-E preparations in our previous article here.

Get Ahead in the Game

With all the learning resources ready, agencies should start preparing now to minimize the disruptions in the OASIS documentation workflow. Take advantage of the Guidance Manual and draft instrument for early training of clinicians while the final version of the OASIS-E awaits release towards the end of 2022. Collaborate with your QA provider to aid clinicians in familiarizing themselves with the changes and making sure that new OASIS assessment data are accurately applied. Make sure to update your QA program to maintain compliance and apply any new mechanisms to optimize reimbursements.

Start talking about OASIS-E with your QA provider at the earliest opportunity to get on top of the new OASIS-E and the bigger move of the industry to transition to value-based care.

Quick links

• Updated OASIS-E Instrument Draft
• Log of changes since Feb 2022
• OASIS-E Guidance Manual Draft

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With the release of the latest OASIS-E draft last February 1, now is good timing for home health agencies to already start training with the new changes. By January 1, 2023, the OASIS-E will be implemented in line with the nationwide expansion of the Home Health Value-Based Purchasing (HHVBP) Model.

Many new changes will shift the entire structure of the OASIS. All current revisions are consistent with the Improving Medicare Post-Acute Care Transformation (IMPACT) Act to promote interoperability between care settings. By having identical data assessment items as other settings, interoperability will increase when each setting uses the same criteria to complete the data set.

The data elements of OASIS-E will also aid in addressing the needs of individual patients with a focus on executing care delivery to patients holistically. Overall, there will be improvements in the safety and quality of care to patients.

What’s New in OASIS-E

Restructured Sections

There are now sections in the data set representing letters A through Q wherein many new assessment items beginning with those letters can be found, as well as the current OASIS D1 items divided under these new sections. 

Some of the current assessment items will remain with the character designation of “M” but many will be placed in the corresponding lettered section with similar items. For instance, Section M in OASIS-E represents the integumentary system, so only “M” items that pertain to wounds will be here. Other current “M” items will be placed in the letter section they correspond with. Another example is the M1720 “When Anxious,” which will be located in Section C together with other new cognitive items, such as the “Brief Interview Mental Screening” (BIMS) and the “Confusion Assessment Method” (CAM).

New Assessments

Here is a rundown of new facets to the OASIS-E, which includes additional assessment items:

• Social determinants of health (SDoH)

Agencies will now be able to collect and identify these actionable items, which should ultimately lead to better patient outcomes. 

• Facilitation of the transfer of health information between post-acute providers

The new OASIS-E will include a new Transfer of Health (TOH) information item. The timeliness of a reconciled medication list to a subsequent provider in the next care setting, or a patient when discharged, will now be measured. Soon, the transfer of health information will be added to the Home Health Quality Reporting Program. Research shows that poor patient outcomes are directly related to medication issues, which is why this development is so important for medication reconciliation and education to address this problem and push better patient outcomes.

• New assessment questions for high-risk medication teaching

A new OASIS item N0415 specifically identifies the high-risk drug classes, such as antipsychotics, anticoagulants, antibiotics, opioids, antiplatelets, and hypoglycemic drugs, which CMS requires patient teachings for.

• Additional behavioral assessments

1. Brief Interview for Mental Status (BIMS) – This will establish a cognitive baseline by testing recall and temporal orientation.
2. Signs and Symptoms of Delirium – This helps to identify delirium, which is often reversible if identified early.
3. Patient mood interview – This is an expanded depression screening, which will give further details on the severity of depression.

• Other notable changes

1. Addition of “Patient declines to respond” as an option to the following items:

• A1005 (Ethnicity)
• A1010 (Race)
• A1250 (Transportation)
• B1300 (Health literacy)
• D0700 (Social isolation)

2. Expanded questions on pain and infusion

Transition Challenges

OASIS data collection directly impacts payment and outcomes. Data from home health reimbursements in relation to the OASIS functional items will also be used in the value-based purchasing program in 2023. Thus, it is important that the data accurately reflects the status of the patient.

It will be a learning process leading up to the implementation of OASIS-E next year. The mental health assessment alone will take some education on the clinician’s part because it is not typically part of their tasks.

With all these considered, clinicians must have a thorough understanding of OASIS and how it plays an impact at start, at resumption, and at discharge. 

Prepare Now

According to recent survey data, about 40% of agencies currently do not have a plan in place for OASIS-E. However, there is no better time to start preparing than now, so there is more room for learning and adjustment for clinicians.

While the final version of OASIS-E is yet to be released later this year, agencies can take advantage of draft versions for early training of clinicians. It may take some time for clinicians to get everything right with all the new changes in the OASIS-E documentation. Your QA program will be of great help in maintaining documentation accuracy and optimizing reimbursements. Start talking about OASIS-E with your QA provider at the earliest opportunity to get on top of the new standards and guidelines.

The updated OASIS-E draft can be downloaded here>

The post [UPDATED] Major Changes in the new OASIS-E: Restructured Sections, Additional Assessments first appeared on Qavalo.