The CMS publishes agencies’ aggregated OASIS process and outcome data on the Home Health Compare website (https:// www.medicare.gov/homehealthcompare). This site is designed for the public – that is, consumers of health care, including patients, family members, professional providers, hospital discharge planners, and anyone else interested in the quality of home care services. The site enables consumers of home health services to identify and choose the agencies with the best processes and services. Patients and referral sources use this website when choosing and recommending home health agencies. The publicly reported data on the site has a huge impact on an agency’s effort to grow and maintain patient referrals. The uses for OASIS data have continued to evolve over the years, with significant quality and payment implications tied to OASIS information. The CMS attaches star ratings to each agency’s OASIS data, making it even easier for consumers to compare agencies. Agencies with the best processes and outcomes are awarded five stars, whereas agencies with the worst quality OASIS data are branded with only one-star. Currently, the CMS continues to move toward a value-based reimbursement system in which compensation is based on the quality of care provided by the agencies. Agencies with the best OASIS measures will be rewarded with “premium payments,” whereas agencies with poor OASIS data will feel the repercussion of lower payments for the care provided to their patients, which will threaten their very survival.
The OASIS instrument is also expected to play a pivotal role in post-acute care quality improvement as advances are made related to the mandates of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. This Act requires the CMS to compare the care provided to Medicare and Medicaid beneficiaries in post-acute settings, which include, not only home health agencies, but also skilled nursing facilities, inpatient rehabilitation facilities, and long-term care hospitals. The future, if not the survival, of the home health industry depends on home health agencies producing good outcomes for their patients as measured by OASIS data. The CMS continues with ongoing efforts to update and refine OASIS as required by congressional mandates and by the science of quality measurement. The CMS aims for constant improvement of OASIS’s ability to measure home health quality indicators, including items related to safety, timeliness, effectiveness, efficiency, equity, and patient-centeredness (CMS, 2019). The CMS’s efforts at refining OASIS have meant that, since 1999, home health clinicians have had to master the nuances of multiple versions of the OASIS instrument: OASIS-B, OASIS-B1, OASIS- C, OASIS-C1, OASIS-C2, OASIS-D, and most recently OASIS-D1, which was implemented on January 1, 2019. With each new OASIS version, some new items have been added, some items have been deleted, and many items have been reworded and refined. Frequently, the instructions for answering old items are updated. Staying current with the latest OASIS guidance can be challenging for home health therapists.
DESCRIPTION OF THE OASIS INSTRUMENT
The following sections define the components and introduce the guidance related to the items within the body of the OASIS instrument. OASIS questions The OASIS instrument is made up of 90 requests for data – that is, 90 items or questions. Each item is assigned a number and each item number is preceded by an “M,” indicating that it is part of the CMS home health data set. There are several additional OASIS questions not preceded by an M – these are either GG or J items . These items were adopted from other post-acute care data sets and retained their original identification number.) In OASIS’s early days, noting that the first 17 OASIS items were preceded by an M and two zeros (such as M0060 – Patient’s Zip Code), which looked like the word “moo,” people started calling them “Moo” numbers. It is still possible OASIS sections The 90 OASIS items are divided into 19 sections, which are identified in Table 1: OASIS Topics and Sections. Most of these sections ask about the patient’s status on a number of clinical, physical, mental health, and other dimensions. Each section theoretically has room for one hundred questions, but
to hear healthcare workers referring to individual items by their “Moo” numbers. Although there are 90 questions on the OASIS instrument, the qualified clinician collects more than 90 pieces of OASIS data on each patient. For instance, M1060 asks about the patient’s height and weight, which is two pieces of data. Furthermore, on discharge, M1311 – concerning unhealed pressure ulcers – asks for 12 pieces of data (which should all be zeros!). In other words, many of the OASIS questions have multiple subquestions.
fortunately even the section with the most questions – the Patient Demographics section – has only 16 questions. Many sections have only one or two questions (see Table 1). The 19 sections will be discussed later in the chapter.
Table 1: OASIS Topics and Sections M Numbers Topics M0010-M0018 Agency Data M0020-M0150 Patient Demographics M0080-M0100 Clinical Record Items
Number of Questions Chapter 3 Section
4
Patient Tracking
16
3
Clinical Record Items
M1000s M1100s M1200s M1300s M1400s M1600s M1700s M1800s
History and Diagnoses Living Arrangements
12
Diagnoses
1 2
Living Arrangements
Sensory Status
Sensory Status
Integumentary Status Respiratory Status Elimination Status
10
Integumentary Status Respiratory Status Elimination Status
1 4 6 9
Neuro/Emotional/Behavioral Status
Neuro/Emotional/Behavioral Status
Activities of Daily Living (ADLs)/Instrumental Activities of Daily Living (IADLs)
ADLs/IADLs
M1900s
Prior Function/Fall Risk
1
EliteLearning.com/Physical-Therapy
Book Code: PTCA2622B
Page 66
Powered by FlippingBook