Transcript OASIS-C - Tennesse Department Of Health

OASIS-C
Outcome and Assessment Information Set
Outcome and Assessment Information
Set (OASIS)
OASIS is a group of standard data elements
developed, tested, and refined over the past
two decades through research and
demonstration program funded primarily by the
Centers for Medicare and Medicaid Services
(CMS). OASIS data elements are designed to
enable systematic comparative measurement of
home health care patient outcomes at two
points in time.
OASIS
Outcome measures are the basis for outcomebased quality improvement (QBQI) efforts that
home health agencies can employ to assess and
improve the quality of care they provide to
patients. In 1999, Medicare certified HHAs
began collecting and submitting OASIS data
related to adults (18 years and older) and nonmaternity patients receiving skilled services with
Medicare or Medicaid as the payer source.
OASIS
The comprehensive assessment and OASIS data
set requirements apply to Medicare certified
home health agencies and to Medicaid home
health providers. OASIS is not collected on
patients under the age of 18, maternity patients,
patients receiving personal care only, or patients
receiving a single visit in a quality episode.
Comprehensive Assessment
The Start of Care (SOC) comprehensive
assessment must be completed on or within 5
calendar days after the SOC date and in
compliance with agency policies. The initial
assessment must be completed by an RN, if the
nursing orders exist at the SOC, and by
appropriate, qualified therapist, if no nursing
orders exist.
Comprehensive Assessment
Only one individual completes the
comprehensive assessment. Even if two
disciplines are seeing the patient at the time a
comprehensive assessment is due, while care
coordination and consultation are needed, only
one individual actually completes and records
the assessment. When both RN/PT/SLP are
ordered on the initial referral, the RN must
complete the SOC comprehensive assessment.
Start of Care (SOC)
The SOC date (M0030) is the date of the first
billable visit and is maintained as the SOC until
the patient is discharged. Even if a new service
enters the case during the episode of care, the
SOC date is still the first billable visit during the
episode of care.
Resumption of Care
It is not required that the Resumption of Care (ROC)
comprehensive assessment be completed on the first visit
following the patient’s discharge from an qualifying
inpatient stay. However, the ROC must be completed
within 48 hours of discharge following a qualifying
inpatient stay or within 48 hours of knowledge of a
qualifying stay in an inpatient facility. If the Agency
becomes knowledgeable about the inpatient stay through
an agency staff that is not qualified to conduct an
assessment, the agency must send a qualified clinician to
conduct a visit and complete both the transfer and the
ROC.
Resumption of Care
At the ROC, there is no regulatory language allowing
the ROC to be delayed by physician order, greater
than 48 hours from the inpatient facility discharge.
The agency should make every effort to complete
the ROC assessment within the 48 hours from the
qualifying inpatient discharge. If the patient refuses
or isn’t available, the ROC should be completed as
soon as possible.
Recertification (follow-up) Assessment
A Medicare/Medicaid skilled-care adult patient
who remains on service at a HHA into a
subsequent episode requires a follow-up
comprehensive assessment during the last 5
days of each 60 day period until discharged. If a
patient is hospitalized and returns to the HHA
during the last 5 days of an episode, the
Resumption of Care (ROC) assessment should be
completed fulfilling both the ROC and
recertification requirements.
Recertification vs Resumption of Care
A patient was discharged from an inpatient facility
on day 53, would the HHA be required to do a
recertification or resumption of care? The HHA will
be required to do a ROC on day 54 or 55. A ROC
has to be completed within 48 hours of an
qualifying inpatient stay.
A patient was discharged on day 54 or 55, would
the HHA be required to do a recertification or
resumption of care? The HHA will be required to do
a ROC no later than day 56 or 57.
Day of Assessment
Home care visits can occur at any time of the day
and to standardize the timeframe for assessment
data, the “day of assessment” refers to the 24 hour
period directly preceding the assessment visit, plus
the time the clinician is in the home conducting the
assessment. The standard definition ensures that
fluctuations in the patient status that may occur at
particular times during the day can be considered in
determining the patient’s ability and status,
regardless of the time of day of the visit.
Drug Regimen Review
A drug regimen review should be conducted on all medications including
prescribed and over the counter administered by any route (oral, topical,
inhalant, pump, and injection). All drugs are not considered “potential clinical
significant medication issues.” It includes serious drug-drug, drug-food, and
drug-disease interactions and are those that “pose an actual or potential
threat to patient health and safety.” Not all clinical side effects are
considered “potential clinically significant medication issues.” A side effect
would be considered a “potential clinically significant medication issues.” if it
“poses an actual or potential threat to patient health and safety.” The
determination of whether a medication issue meets this threshold should be
based on the clinician’s judgment in conjunction with agency guidelines and
established standards for evaluating drug reactions and interactions.
Drug Regimen Review
Collaboration in which the assessing clinician
evaluates patient status and another clinician
assists with review of the medication list does not
violate the requirement that the comprehensive
patient assessment is the responsibility of and
must be completed by one clinician. RN, PT, OT, PT
and the pharmacist can collaborate with the
assessing clinician. However, the agency policy and
practice determines how the pharmacist
participates in the drug review and how it is to be
documented.
Drug Regimen Review
The physician or the physician designee must be
contacted within one calendar day to resolve
clinically significant medication issues including
reconciliation. A “Yes” can be selected if the
two way communication AND reconciliation (or
plan to resolve the problem) must be completed
by the end of the next calendar day
Drug Regimen Review
If a medication related problem is identified and
resolved by the agency staff by the time the
assessment is completed, the problem does not
need to be reported as an existing clinically
significant problem.
Drug Education
If agency staff, other than the clinician responsible
for completing the SOC/ROC OASIS, provided
education to the patient/caregiver on high-risk
medications, this information must be
communicated to the clinician responsible for the
SOC/ROC OASIS assessment so that the appropriate
response for M2010 may be selected. This
collaboration does not violate the requirement that
the comprehensive patient assessment is the
responsibility of, and ultimately must be completed
by one clinician.
Medication Follow-up
Medication follow-up is only collected at the
SOC and ROC. The item must be answered
within the timeframe allowed at SOC/ROC to
ensure compliance with the Condition of
Participation regarding the completion of the
comprehensive assessment. If a medication
issue is identified, the communication and
reconciliation must occur within one calendar
day of identification and before the end of the
allowed timeframe in order to answer “yes.”
Medication Follow-up
For process measure items reporting
communication to and from the physician or
physician designee, such as M1510 or M2002,
communication can be directly to and from the
physician, or indirectly through physician’s office
staff on behalf of the physician in accordance
with the legal scope of practice. This is different
from the process measure M2250 for physician
orders and must come directly from those
physicians as defined in M2250 item set.
At home Therapies (1030)
At home therapies refer to intravenous and infusion
therapy, parenteral nutrition, or enteral nutrition
that the patient received at home (place of
residence). Intravenous means administration via
IV line or IV catheter. Infusion therapy means via
central line, subcutaneous infusion, epidural
infusion, intrathecal infusion, or insulin pump.
Parenteral nutrition means TPN or lipids. Enteral
nutrition means administration via G-tube, J-tube,
or PEG-tube
At home Therapies
Hemodialysis and peritoneal dialysis in the home is
considered as infusion therapy.
When a patient has a G-tube, J-tube, or PEG-tube
and it is only utilized for the administration of
medication or water for hydration, it is not
considered as nutrition. Any oral electrolyte
solutions such as Pedialyte that are administered to
prevent dehydration are not considered as
nutrition.
ADLs
Most of the items under the ADLs component
identifies the patient’s ABILITY, not necessarily
actual performance. “Willingness” and
“compliance” are not the focus of these items.
These items address the patient’s ability to
safely perform a task, given the current physical
and mental/emotional/cognitive status,
activities permitted, and environment. The
patient must be reviewed from a holistic
perspective in assessing ability to perform ADLs.
ADLs
When a patient’s ability varies on the day of
assessment, the clinician reports what was true
for a majority of the time. If a patient’s ability
varies among the tasks in a single OASIS item,
select the response that represent the patient’s
status in the majority of the tasks.
ADLs
When scoring the OASIS, clinicians should avoid
applying “always”, “never”, or “automatically “
rules. Each item, the response options
contained in the item, and additional available
guidance should be reviewed in order that the
most accurate response can be selected.
Standardized Tools
For items M1240, Pain Assessment, M1730,
Depression Screening, and M1910 Fall Risk
Assessment, a standardized tool must be used.
A standardized tool is one that has been
scientifically tested and validated. A
standardized tool includes a standard response
scale and must be appropriately administered
based on established instructions.
Standardized Tools
To meet the need of pain assessment, the
depression screen or the multi-factor fall risk
assessment referenced in the OASIS, an agency
may use a standardized tool from any
organization able to effectively develop, test,
and validate the tool for use on a population
similar to that of the patient(s) being assessed.
Living Arrangement
The intent of M1100 is for the assessing clinician to
determine whether the patient is living alone or
with others and the availability of caregiver(s)
(other than home health agency staff) to provide inperson assistance. To answer this item set, you
must first determine the living arrangement
(whether the person lives alone, in a home with
others, or in a congregate setting), and secondly,
determine the availability of assistance (how
frequently caregiver(s) are in the home and
available to provide assistance if needed).
Sensory Status
The intent of M1230 is to identify the patient’s
physical and cognitive ability to communicate
with words (through vocalization of ideas,
feelings, and needs) in the patient’s primary
language. The item does not address
communicating in sign language, in writing, or
by any nonverbal means including message
boards, electronic devices that convert text to
speech or a speech generating device utilizing
symbols and a keyboard.
Respiratory Status
M1400 identifies the level of exertion or activity
that results in a patient’s dyspnea or shortness of
breath. If the patient uses oxygen continuously,
select the response based on assessment of the
patient’s shortness of breath while using oxygen. If
the patient uses oxygen intermittently, mark the
response based on the patient’s shortness of breath
WITHOUT the use of oxygen. The response is based
on the patient’s actual use of oxygen in the home
and not on the physician’s oxygen order.
Respiratory Status
For a chairfast or bedbound patient, evaluate
the level of exertion required to produce
shortness of breath. When completing M1400,
the assessing clinician will assess and report
what caused the patient to experience dyspnea
on the day of the assessment.
Cardiac Status
Communication to the physician or primary care
practitioner can be by telephone, voicemail,
electronic means, fax, or any other means that
appropriately conveys the message of patient
status. The same day means the physician has
responded to the agency communication with
acknowledgement of receipt of information and/or
further advice or instructions by the end of this
calendar day. The communication must be between
the physician and agency and not physician and
patient/caregiver.
Elimination Status
The term “past fourteen days” is the two week
period immediately preceding the
start/resumption of care or discharge. This
means that for purposes of counting the 14-day
period, the date of admission is day 0 and the
day immediately prior to the date of admission
is day 1. For example, if the patient’s SOC date
is August 20, any treatment for a UTI on or after
August 6 would be considered. This definition is
also used for other OASIS items.
Outcome-Based Quality Monitoring
(QBQM) Reports
QBQM reports resulting from the transmission of
OASIS data are intended for use in the agency’s
quality improvement program. The two reports are
the Agency Patient Related Characteristics Report
and the Potential Avoidable Event Report. The
Agency Patient Related Characteristics Report
presents characteristics of the agency’s patients at
start or resumption of care. The Potential
Avoidable Event Report displays incidence rates for
infrequently occurring untoward events
(outcomes).
QBQM Reports
The Agency Patient Related Characteristics Report
indicates how your agency patient characteristics
profile of your home health agency compares to
both a national reference sample and your agency
from a prior period of time. The report presents a
picture or snapshot of what your agency’s patients
look like at the beginning of a care episode. It also
includes discharge information such as lengths of
stay and reasons for emergent care and
hospitalizations.
QBQM Reports
Where does the data for the Agency Patient
Related Characteristics Report come from? Your
agency’s start of care, resumption of care, and
transfer/discharge/death at home assessments
provide the data for the great majority of the
agency patient related characteristics variables.
It represents an aggregation of OASIS patient
status data at the beginning and at the end of a
episode of care.
QBQM Reports
The Potentially Avoidable Event Reports rely on
information from both the start or resumption
of care assessment and OASIS data collected at
transfer, death at home, or discharge. A
potentially avoidable event reflects a serious
health problem or decline in health status for an
individual patient that potentially could have
been avoided.
QBQM Reports
The potentially avoidable events included in this
report are outcome measures, in the sense that
they represent a change in health status
between start or resumption of care and
discharge or transfer to inpatient facility. For
most potentially avoidable events, change in
health status is measured directly (for example,
increase in number of pressure ulcers).
Quality Based Quality Improvement
(QBQI) Reports
What are QBQI reports?
The QBQI reports is a tool that HHAs can use to
help them understand the agency’s care
practices. The QBQI reports are available via the
CASPER (Certification and Survey Provider
Enhanced Report) Reporting application.
QBQI Reports
An improvement in any particular health status
outcome is calculated from the respective OASIS
data item. A patient improves when the scale
value for the particular health attribute being
measured indicates less impairment at discharge
than at start or resumption of care.
QBQI Reports
Patients are excluded from a specific
improvement measure computation if they were
not impaired in a specific attribute at start or
resumption of care.
QBQI Reports
The stabilization and improvement measures
cannot be calculated from the OASIS transfer
data—they can only be calculated from the
patient status information provided from the
comprehensive assessment performed at
discharge. The transfer information is used in
computing the utilization of outcomes.
QBQI Reports
An outcome episode begins with a start or
resumption of care and ends with a transfer or
discharge. A patient who has a resumption of
care and a discharge, for example, within the
report period you specify will be included in the
outcome report. He or she does not need to
have a SOC within that period; the ROC will
suffice as the start of the episode.
QBQI Reports
All patients who have complete care episodes
(beginning with SOC or ROC and ending with a
transfer or discharge) are included in the
computation for the utilization outcomes. All of
these patients had the potential to be
discharged to the community, to be hospitalized,
or to receive emergent care. Only patients for
whom a discharge comprehensive assessment
was completed are included in the computations
for the end result outcomes.
Sources
Chapter 3, OASIS-C Guidance Manual
and
Quarterly Questions and Answers
(December 2012 through July 2014)
Contact Information
Madeline Coleman, RN, MS, JD, CPHQ
Manager, Quality Improvement and OASIS
Coordinator
665 Mainstream Drive
Nashville, TN 37243
[email protected]
615-741-7534