Table 1: OASIS Topics and Sections M Numbers Topics
Number of Questions Chapter 3 Section
M2000s M2100s M2200s M2300s
Medications
7 1 1 2 4 4
Medications
Care Management
Care Management
Therapy Need and Plan of Care
Therapy Need Plan of Care
Emergent Care
Emergent Care
M2400s, M0906 Transfer/Discharge
Discharge
GGs
Prior Functioning, Device Use, Self-Care and Mobility
Functional Abilities and Goals
Js Health Conditions Note : Adapted from Centers for Medicare and Medicaid Services. (2019). Outcome and assessment information set OASIS-D guidance manual. Effective January 1, 2019. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Downloads/ Falls 2
OASIS-D-Guidance-Manual-final.pdf. OASIS time point versions
Not all of the 90 OASIS questions need to be completed each time you complete an OASIS. OASIS data are collected at various time points during a patient’s stay in home care – at admission (Start of Care [SOC] OASIS); transfer (Transfer to Inpatient Facility [TRN] OASIS, also known simply as Transfer OASIS); resumption of care post-acute hospitalization (Resumption of Care [ROC] OASIS); recertification for another episode of care (Follow-Up OASIS, also known as the Recertification [Recert] OASIS); at discharge (Discharge OASIS); and the Death At Home OASIS, used when the patient dies at OASIS as part of a comprehensive assessment A comprehensive assessment of the patient must be performed at admission, resumption of care (post-acute hospitalization or other inpatient stay that occurs within a patient’s home care certification period), and recertification. Keep in mind that although OASIS must be performed at these times, OASIS is not a comprehensive assessment; it is only part of a comprehensive assessment. There are many assessment items that are part of a therapist’s comprehensive assessment that are not part of OASIS. For instance, there is no place on an OASIS form to record vital signs, heart and lung sounds, or multiple other Types of OASIS questions An OASIS form contains various types of questions. Some of the questions are related to agency and patient demographics and other, similar information. The bulk of the questions, however, include (a) process measurement items, (b) outcome measurement items, (c) risk-adjustment items, and (d) reimbursement items. The following sections consider the purpose of each of these types of questions. Process measures Many assessment and treatment strategies have been identified through research as “best practices.” Some of these assessment best practices include assessing the patient’s risk for pressure ulcers, depression, and falls using standardized and validated assessment tools. Other best practice interventions include providing flu/pneumonia immunizations and teaching patients about medications. The CMS would like to know which agencies use these best practices and if the practices make a difference to outcomes. If the practices are indeed helpful, CMS would also like to encourage these and other “best practices” so that CMS beneficiaries can profit from them. Therefore, as part of the OASIS assessment, the therapist records whether he or she included best practice assessment and intervention strategies when providing care to a patient. Outcome measures When a patient’s status is measured on a specific clinical indicator at start of care and again at discharge from care, a comparison of the two values will show if the patient improved, deteriorated, or stayed the same on that indicator while under an agency’s care. OASIS includes risk- adjusted outcome indicators (CMS, 2020a), such as the patient’s degree of shortness of breath, surgical wound healing, and ability to
home. Not all OASIS items are completed at every assessment time point. For instance, some items are completed only at admission, others are completed only at discharge, and still other items are collected both at admission and discharge. In other words, there is a “mother” OASIS instrument that consists of all 90 questions, but not all 90 questions are ever asked at one patient time point. Instead, there are versions of the OASIS instrument, one for each time point – start of care (admission), resumption of care, follow-up (recertification), transfer, and discharge – each with its own grouping of OASIS items. physical assessment items that are part of a comprehensive assessment of a patient. Therefore, an agency’s forms for the various time points – whether they are electronic or paper forms – incorporate the OASIS items and the nursing assessment items into one integrated form. The sensory section of an agency’s forms, for example, is likely to include the two OASIS questions along with cues for physical assessment items, such as pupil size/ accommodation to light; whether the patient has a hearing aid; and the location, quality, and timing of any pain the patient is experiencing, along with other assessment data. perform activities of daily living (ADLs) safely, which make it easy to determine whether the patient got better, stayed the same, or got worse during the stay in home care. Other outcome indicators measured at admission and discharge and then compared include the ability to manage medications. Other outcome measures include development of new or worsened pressure ulcers, discharge to community, need for emergency care, and need for hospitalization. Risk-adjustment items The CMS posts some of an agency’s aggregated outcomes (data on all of the agency’s patients combined) on a website called Home Health Compare (https://www.medicare.gov/ homehealthcompare/search.html), where each agency can be directly compared with other agencies serving the same geographical area. In order to fairly compare one agency with another, patients in the agencies need to be risk-adjusted. For instance, if one agency tends to see patients who are more elderly or more severely ill than another agency, it would be unfair to compare the outcomes of the two agencies with each other unless the outcomes data have been risk-adjusted. Risk adjustment takes information about each patient’s acuity and condition severity and makes a statistical correction so that the outcomes of different patient populations can be fairly and meaningfully compared with one another. Thus, there are a number of questions on the OASIS assessment whose purpose is to contribute helpful information for these statistical calculations. Reimbursement Home care’s PPS was revised in January of 2020 with the introduction of the Patient-Driven Groupings Model (PDGM). The payment system is a case-mix classification model, relying
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