Over the past two decades, the Outcome and Assessment Information Set (OASIS) has been developed, tested and refined, and major changes continue to occur. Now home health agencies (HHAs) need to be prepared for OASIS-D, which will go into effect on January 1, 2019.
Reasons Behind the Introduction of OASIS-D
The main reason behind the introduction of OASIS-D is the IMPACT Act (Improving Medicare Post-Acute Care Transformation Act of 2014).
- The purpose of the IMPACT Act is to standardize patient assessment data collected for Post-Acute Care (PAC) providers, specifically Long-Term Care Hospitals (LTCHs), Inpatient Rehabilitation Facilities (IRFs), Skilled Nursing Facilities (SNFs), and Home Health Agencies (HHAs). The standardization of data develops an improved quality measure (QM). Plus, the data can be utilized to compare all four PAC providers for quality.
- Another key area the IMPACT Act seeks to improve is the coordination of care and discharge planning between the post-acute care providers and the transition from acute care to post-acute care.
- The changes in OASIS-D for the Impact Act are making it feasible to obtain reports of “what happens where to a patient”. For example – did a new or worsening pressure ulcer occur during a home health admission or a long-term care admission? Were functional abilities improved during home health for a patient as the agency projected they would improve?
OASIS-D does have a lot of deletions, causing CMS to estimate that the amount of time required to complete the data set will decrease, but as we know, not all OASIS items are equal.
|OASIS-D Deletions||OASIS-D Additions|
|M0903: Date of Last / Most Recent Home Visit||GG0100: Prior Functioning: Everyday Activities|
|M1011: Inpatient Diagnosis||GG0110: Prior Device Use|
|M1017: Diagnosis Requiring Medical or Treatment Regimen Change Within Past 14 Days||GG0130: Self-Care
|M1018: Conditions Prior to Medical or Treatment Regimen Change or Inpatient Stay Within Past 14 Days||GG0170: Mobility
|M1025: Optional Payment Diagnosis||J1800: Any Falls Since SOC / ROC|
|M1034: Overall Status||J1900: Number of Falls Since SOC/ROC|
|M1036: Risk Factors|
|M1210: Ability to Hear|
|M1220: Understanding Verbal Content|
|M1230: Speech & Oral (Verbal) Expression of Language|
|M1240: Pain Assessment|
|M1300: Assessment for Pressure Ulcer Risk|
|M1302: Risk for Pressure Ulcers Identified|
|M1313: Worsening in Pressure Ulcer Status|
|M1320: Healing Status of Most Problematic Pressure Ulcer|
|M1350: Skin Lesion or Open Wound|
|M1410: Respiratory Treatments|
|M1501: Symptoms in Heart Failure|
|M1511: Heart Failure Follow-up|
|M1615: When Does Urinary Incontinence Occur|
|M1750: Psychiatric Nursing Services|
|M1880: Ability to Plan and Prepare Light Meals|
|M1890: Ability to Use the Telephone|
|M1900: Prior Functioning ADL/IADL|
|M2040: Prior Medication Management|
|M2110: How Often Does the Patient Receive ADL or IADL Assistance from Caregiver|
|M2250: Plan of Care Synopsis|
|M2430: Reason for Hospitalization|
The GG items are set up very much like the GG0170 item that was introduced last year in that OASIS iteration (lying in bed to sitting on side of bed with feet on the floor). They all have the six-point scale with which to score depending on the type of assistance the patient needs to perform each task. And, they all have the projected score for each item at discharge.
The difference is that there are many more items to assess for each GG item and this will take time, assessment strategies, and more than one visit – so utilization of the five-day assessment period with collaboration of the varied disciplines in the team.
When you read the GG items for the first time, you will be surprised at the level of detail in many of the items. Here is the synopsis of each one:
GG0100: Prior Functioning: Everyday Activities
Self-care items – bathing, dressing, toileting, and eating.
GG0110: Prior Device Use
This is just to select the device.
GG03130: Self Care
This item is a very specific one with eating, oral hygiene, toileting hygiene, shower/bathe self, upper body dressing, and putting on/taking off footwear. All have specifics for each section and this is for assessment SOC/ROC and discharge and follow up when applicable.
This item is beyond specific and includes:
Roll left and right
Sit to lying
Lying to sitting on side of bed, which we already have been doing for the past year
Sit to stand
Chair/bed to transfer
Walk 10 feet
Walk 50 feet with 2 turns
Walk 150 feet
Walking 10 feet on uneven surfaces
1 Step (curb)
Picking up object
Wheel 50 feet with 2 turns
Wheel 150 feet
So, in reading the new GG items, you can understand why the collaboration of the multi-disciplinary team and the five-day assessment window are necessary in order to accurately identify what your patients are able to do, as well as what their discharge goals are.
JJ Items are looking at falls, asking in JJ1800 if there have been falls since the most recent SOC/ROC, and then in J1900, how many falls have there been.
The CMS OASIS Guidance Manual has very specific examples for the GG and JJ items and are very helpful to train your clinicians.
You do not Need to be Overwhelmed!
5 Star Consultants is here to help you navigate the changes OASIS-D will bring to your HHA. Our home health experts are providing OASIS-D training and can do so for your agency! Find out today about how we can help ensure your team is ready for OASIS-D on January 1, 2019. To learn more, please contact us at [email protected] or 866-428-4040.