Chapter 5: Home Health Therapy: Using OASIS, Updated 3 CC Hours
By: Mary Curry Narayan, MSN, RN, HHCNS-BC, COS-C, CTN-A Learning objectives After completing this course, the learner will be able to: Explain the evolution and purposes of the OASIS instrument. Describe the OASIS instrument. Describe the rules about when, by whom, and how the OASIS instrument is completed. Course overview Home health care is the fastest growing industry in the United States, based upon the projection period of 2014 to 2024. The anticipated growth in jobs for the time period is more than 760,000, projected to reach a total of more than 2 million (Henderson, 2015). The demand and competition for licensed rehabilitation therapists to work in home health care is, and will continue to be, great (AMN Healthcare, n.d.). Therapists currently working in or planning to work in home health agencies must have an understanding of the significance of process and outcomes measurement. The O utcome and AS sessment Information S et (OASIS) is a specific assessment and outcomes measurement instrument that consists of 90 items or questions and measures patient data at various times during the patient’s stay in home care. Mandated by the Centers for Medicare and Medicaid Services, OASIS data must be collected on Medicare and Medicaid patients at various times during a patient’s stay in home care. Therapists must be aware of the time sensitive and accuracy requirements related to documentation, OASIS updates, and the level of compliance and denials their agency experiences. Feedback related to documentation compliance and any denials will help therapists to refine and improve utilization of the tool for both improved patient outcomes and optimum reimbursement. (Note: For agencies that do not provide skilled services to Medicare or Medicaid patients, the therapist should refer to agency-specific required assessment, documentation, and billing tools that record plans of care, services delivered, and capture information in order to obtain payment.) The Outcome and Assessment Information Set plays a crucial role in each patient’s assessment and reassessment at specific points during the patient’s stay in home care. Accurate, timely, and complete documentation of OASIS is vital in determining how much an agency is paid for each care episode and provides
Explain when and how to use Chapter 3 of the OASIS-D Guidance Manual . Identify each of the items within the OASIS-D dataset.
documentation to support the quality of care delivered. The completion of this series of documents is important on an individual patient level, but also in the aggregate for the agency’s population and when used in local, regional, and national benchmarking in support of the agency’s reputation and financial health. The purpose of this course is to provide home healthcare physical and occupational therapists and speech-language pathologists with the information they need to understand the significance and importance of effectively using the OASIS instrument in order to deliver comprehensive, compassionate, patient-focused, and cost-sensitive skilled services in the home environment. The home health therapist will be able to use the OASIS information provided in this course to create a basis for the plan of care, to measure the patient’s progress in meeting the established home healthcare goals, and to meet the regulatory requirements for quality reporting and reimbursement. Completion of this course will provide the inexperienced home health therapist with knowledge needed to begin working with the OASIS tool as part of an orientation in delivering certified home health therapy and overall care. Experienced home health therapists will find opportunities to review, reinforce, revise, and refine or expand their working knowledge of OASIS requirements and to grow in understanding the professional implications of practicing in this complex and challenging healthcare setting. This course focuses on OASIS-D1, the most recent update to OASIS, which went into effect on January 1, 2019. It is recommended that the reader view or print out the OASIS form as a reference while reading the course. It is available at https://www.cms.gov/Medicare/Quality-Initiatives- Patient-Assessment- Instruments/HomeHealthQualityInits/ Downloads/OASIS-D_All-Items_final.pdf.
EVOLUTION AND PURPOSES OF OASIS
OASIS was originally developed and introduced to the home care industry as a standardized patient assessment and data collection tool in 1999. The Centers for Medicare and Medicaid Services (CMS) had been concerned about the quality and cost of the care provided to CMS beneficiaries and wanted to measure the quality of each agency’s services by comparing the outcomes of care that each agency was able to achieve for its patients. The CMS hoped to identify agencies that demonstrated best patient outcomes, along with the “best practices” they used to achieve those outcomes. They planned to share these best practices, enhancing the care provided to all Medicare and Medicaid beneficiaries. The CMS also encouraged agencies to use the outcomes data they received to focus on “outcomes- based quality improvement” efforts. A year after the initial OASIS rollout, the CMS needed to make the transition to a prospective payment system (PPS) – versus the visit-based payment system that had been in effect since 1965 – as mandated by the Balanced Budget Act of 1997.
The CMS decided to use items on each patient’s Start of Care OASIS Assessment to determine how much the agency would be paid for each patient’s care. Thus, in addition to its quality improvement applications, OASIS information became the foundation for the home health PPS of reimbursement. Currently, information derived from OASIS assessments is used for multiple purposes and initiatives. Agency leaders use OASIS data to benchmark their agencies against others in order to evaluate their own agencies’ strengths and weaknesses. They also use their agencies’ data in their quality assurance and quality improvement efforts. They scrutinize their Potentially Avoidable Events Reports to identify opportunities for improvement and use their outcomes data to develop outcome- based quality improvement initiatives (CMS, 2020a). Medicare surveyors also review agencies’ outcome data to determine compliance with Medicare conditions of participation (CoPs) and to review the quality of agencies’ programs.
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Book Code: PTCA2622B
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