04 Nov OASIS-D CHANGES
What Agencies Should Know About the OASIS-D Changes Effective January 1st 2019
Alora is committed to keeping home health professionals informed about regulatory changes that affect your businesses, patients, and staff. With December right around the corner, many are preparing for the January first, 2019 implementation date for OASIS-D.
OASIS-D & How it Will Affect Home Health Providers
On January 1, 2019, the Centers for Medicare and Medicaid Services (CMS) have scheduled implementation of the revision to the home health assessment data collection tool, The Outcome and Assessment Information Set (OASIS-D). The aforementioned tool will reduce the burdens of data collection and are inclusive of updates consistent with the IMPACT Act (Improving Medicare Post-Acute Care Transformation Act of 2014). The IMPACT Act sets forth requirements for standardization of patient assessment data. This standardized data has been put in place to allow cross-setting data collection, exchangeable data, outcome comparison, and comparison of quality with regard to PAC settings.
Historically speaking, OASIS (the Outcome & Assessment Information Set) is defined as “A group of standard data elements….designed to enable systematic comparative measurement of home health care patient outcomes at two points in time. OASIS-based quality measures can be used for quality improvement efforts which home health care agencies can employ to assess & improve the quality of care providers deliver to patients.”
The latest revision of the OASIS data set which is referred to as (OASIS-D), is designed to heighten standardization measures across the post-acute environment to better facilitate accurate calculation of cross-setting quality measurements, in accordance with the requirements of the previously cited IMPACT Act of 2014.
The focus of OASIS D in this latest revision is on quality and comparison of quality indicators. The new set is inclusive of a larger number of functional items that home health care clinicians will be required to assess, as well as a general modification of the questions which address fall history, and pressure ulcers.
Some of the main changes cover:
- Comparison of quality indicators
- Additional functional assessments
- Modification of pressure ulcer questions
- Additional fall history questions
- Removal of select M items
Additionally, one critical item to note is with regard to the case mix calculation. This calculation will not be affected by updates to the overall OASIS data set. The majority of the emphasis falls mostly on universal quality and standardization spanning all post-acute care providers.
Some have identified a set of possible challenges to these new implementations. The first of those challenges, functional assessments which are required from the outset of care under the new OASIS-D parameters, could reasonably become a burden to home health providing agencies. This is largely due to the fact that the new data set is inclusive of an assessment of functional areas which don’t normally include a comprehensive OASIS assessment, absent an order of therapy. Once such example of this scenario, could be a circumstance of walking on uneven ground, curbs, or movement into a motor vehicle.
While some have concerns about obstacles to agencies, the new OASIS-D could hold many benefits as well. CMS should emerge post implementation with the ability to track the comparison of quality outcomes with far greater accuracy between post-acute providers. This is worth noting, as it positions a more comprehensive and effective monitoring towards the achievement of greater quality patient outcomes within the home health care environment.
Preparation for OASIS-D offers somewhat straightforward advisement to providers. The suggestions that CMS have recommended include updating to the latest electronic medical record (EMR) platform, as well as providing training and education to staff on the latest revisions. Once OASIS-D is in place after January 2019, it is recommended that quality assurance programs are put in place to better ensure accurate staff adoption of all important procedures.
In essence, prior to the end of December of 2018, Home health agencies need to adequately prepare for OASIS-D implementation well in advance, as the alternative to adherence is financial penalty. One big impact of the new rules falls within the area of reimbursements. According to CMS, the overhaul to OASIS-D affects over 32 items, cumulatively resulting in the collection of approximately 235 fewer data elements within a singular home health episode. The proposal could also include a set of items affecting interoperability, specifically for the IMPACT ACT. Proper data entry by staff will be crucial to ensure reimbursements occur without interruption or delay. Simple errors like failure to accurately complete a field, or improper information being placed in data fields could easily result in a denial from CMS. Agency management will need to enact updated policies and practices to reduce errors encountered while filling out OASIS forms. No agency wants to leave money on the table, so a proactive approach to staff training on assessments will pay off big in the long run..
Any time changes are made to OASIS, compliance should be at the forefront of every provider’s mind. Agency staff members will need to be trained on the intricacies of the new measures. The January proposed changes to OASIS are extensive, but historically speaking, even minor adjustments generally demand additional training hours for staff to ensure full compliance.
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