Oasis-C Changes
OASIS-C changes and what they mean to your agency
With the new OASIS-C changes looming around the corner, many agencies have sought information through online seminars and plenty of reading material. Most of the information is comprehensive and provides much detail on what is changing for OASIS this next year.
Select Data thought it would be valuable to take the time and provide the most commonly asked questions while working with agencies. We have compiled the top 5 most asked OASIS-C questions.
Question 1
Are the changes to the OASIS as extensive as what the industry predicted in 2008?
A. Yes. While the 2008 data set saw a focus on refinement of financial data sought, the 2010 OASIS data set is focused upon the clinical assessment of the patient, data collected, and necessary screenings completed that will impact the discipline specific careplan and ultimately the overall medical Plan of Care (485). The new OASIS-C will have a strong impact on 2010 outcome scores as well as agency revenue. Inaccurate OASIS reporting can be a direct link to increased audit risk from both the MACs and the RACs which can lead to disrupted cash flow.
Question 2
Our therapists want to utilize their own evaluation tools when completing their assessment. Do you see any issues with that approach?
A. Therapists seem to use a variety of tools, tests, and measures, but for inter-rater reliability issues, the same tests must be utilized to verify status of the patient upon admission and discharge . Choose certain tools that your agency will designate as approved benchmark tools. Agency outcomes will be dependent on proper tools and outcome measurement.
Point of interest: Many coders comment that therapists, by and large, discover a high number of patient co-morbidities. That occurs because of the nature of their assessment “show-me†process and the number of tools used.
Question 3
Some agencies are providing their clinicians with a copy of Chapter 3 of the OASIS-C Guidance Manual. Do you think this is necessary?
A. The Clinical front line will determine your agency’s bottom line . Chapter 3 contains item specific guidance for each OASIS item. After education regarding the changes in OASIS and the review of OASIS conventions (found in Chapter 1), most agencies are wisely providing the Chapter 3 for ready reference. Remember, the clinician wants a quick and ready reference and you want accuracy provide Chapter 3 or give the link so the clinician can download a copy.
Question 4
What is the biggest difference between OASIS-B and OASIS-C?
A. There are many answers, but remember, OASIS B refinements were focused upon finance. OASIS-C is all about clinical assessment using standardized tools with subsequent processes chosen for intervention and care for the patient.
Risk assessment followed by specific process algorithms is a focus. With OASIS-C, CMS wants to include a way to measure an agency’s use of evidenced based best practices. Since research supports the fact that best practices assist to prevent the exacerbation of serious conditions, then it is easy to see the CMS expectation that processes of care implemented according to evidenced based guidelines will ultimately lead to better clinical outcomes.
Select Data chose to include the assessments for falls, skin integrity, depression, pain, and nutrition. In addition, other screening tools were placed in the Forms Folder, to be used (if the agency permits) for additional screening; i.e. the Geriatric Mood Assessment and other standardized pain tools. Also found in that folder are algorithms that may be used after screening. The Falls Risk Algorithm identifies a process to be triggered (if the agency chooses to use this algorithm) with a score of 10 or more referrals to PT, OT, MSS for specific intervention.
CMS has identified the importance of process process process. While OASIS B focused on data collection and outcomes, OASIS-C clearly focuses on data collection, identifying what the clinician plans to do about that data (the careplan or process plan) and then the outcomes.
Question 5
I understand there were changes in the Diagnosis coding section in the new OASIS.Is that correct?
A. M0230, M0240, and M0246 will be identified as M1020, M1022, and M1024. CMS is seeking an accurate portrait of the patient and their conditions. CMS eliminated the severity level identification and instead moved to listing other diagnoses “in the order to best reflect the seriousness of the patient’s condition and justify the disciplines and services provided”. The diagnoses should be sequenced by ” the degree they impact the patient’s health and need for home health care, rather than the degree of symptom control”. Documentation is key. Expert clinician/coders reviewing the record for proper coding will be vital. Point to note: Be very aware of coding hypertension, GERD documentation, Low vision documentation omissions, diabetes documentation and the correct coding choice (there are over 10), and personal histories of falls.