Updated 11/20/2023

2023 Ushered in the biggest OASIS-E changes to the data set. The Centers for Medicare and Medicaid Services (CMS) completed OASIS-E implementation at the start of 2023 following a delay caused by the ongoing COVID-19 public health emergency.

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According to CMS, the OASIS instrument was revised to increase standardization across post-acute care settings related to the IMPACT Act passed in 2014. Healthcare organizations need to understand the scope and comprehensiveness of these changes. Not only are there many new and retired items, but the entire structure of the OASIS will change.

Elevate Your Understanding of OASIS-E Changes

The OASIS-E changes represent data set item additions and removals, new assessment items, changes in guidance for current items, and a complete restructuring of sections and item numbers to match data assessment items in other post-acute care settings.

Restructuring of OASIS-E Sections In 2023

You will now find sections in the data set representing letters A through Q. Within these sections you will find many new assessment items beginning with those letters, as well as our current OASIS D1 items divided under new sections. 

Many of the existing assessment items remained with the character designation “M” but many were placed in a corresponding lettered section with like items. Section M in OASIS-E represents the integumentary system, so only “M” items that pertain to wounds will be here, other existing “M” items were placed in the letter section they correspond with. For example M1720, “When Anxious,” will be in Section C with other new cognitive items such as the “Brief Interview Mental Screening” (BIMS) and the “Confusion Assessment Method” (CAM).

Additional Assessments Within OASIS-E in 2023

Another area of major change is the new assessments within OASIS-E which include:

• Brief Interview for Mental Status (BIMS), which establishes a cognitive baseline by testing recall and temporal orientation.
• Signs and Symptoms of Delirium from the Cognitive Assessment Method (CAM) to help identify delirium which is often reversible if identified early.
• Patient Mood Interview (PHQ 9), the expanded depression screening, will give further details related to the severity of depression

You should note that the PHQ-2 will still be present in OASIS-E as a gateway assessment. The PHQ-9 would only be completed if the PHQ-2 was positive for depression. A key reminder is that any of these assessment tools are merely screening tools and do not diagnose a condition, which still must come from the provider, but they will help identify issues if present.

Extended OASIS-E Completion Time

Additionally, with these new assessment screenings within OASIS-E comes extra completion time. CMS estimates that once clinicians are familiar with the assessment tools, it will take an additional 2.5 minutes. Under best circumstances for clinicians familiar with the new BIMS, CAM, and PHQ9 assessments, completion of the entire OASIS-E is projected to take an additional 7.5 minutes to complete for just these 3 items.

Significant OASIS-E Changes to Enrich Patient Outcomes In 2023

The revisions to prior versions of the OASIS as well as the 2023 revisions with OASIS-E are all consistent with the IMPACT Act and interoperability between care settings. By having identical data assessment items as other settings, interoperability will increase when each setting uses the same criteria to complete the data set. For those familiar with the MDS data set, you will notice the similarities to the structure of OASIS-E. Overall, there will improvements in the safety and quality of care to patients.

OASIS-E is consistent with other initiatives from CMS, with a focus on executing care delivery to patients holistically. The data elements of OASIS-E aid in addressing the needs of individual patients. Organizations are able to collect actionable items such as social determinants of health (SDOH) that lead to better patient outcomes. Identifying SDOH can help organizations be part of the solution in bridging disparities of health care for this patient population.

OASIS-E Transfer of Health Changes

One significant area of change will be the Transfer of Health (TOH) information item. This represents two companion measures that will measure the timeliness of a transfer of a reconciled medication list to a subsequent provider in the next care setting, or to a patient when discharged. Moving forward, TOH will be added to the Home Health Quality Reporting Program. Understanding the connection between TOH items and adverse events will push patient outcomes above competitors throughout the industry. Research shows poor patient outcomes are directly related to medication issues, thus a need to develop a strong process for medication reconciliation and education to mitigate complications.

Excel with McBee’s Best Practices for OASIS-E Changes

OASIS-D1 has a level of comfort and familiarity. Often, we find that clinicians settled in their comfort zone have not kept up with the OASIS guidance changes and clarifications.

Just like any new process, agencies need to provide support through OASIS-E resources and education. This is not a quick feat amid the ever-expanding expectations of the home health clinician. How can your organization achieve this?

Key points to consider when educating your staff on OASIS-E

• Stay ahead of the curve: Enroll in OASIS-E training courses and subscribe to McBee Insights to stay up to date on our latest resources and live healthcare training opportunities beyond OASIS-E.
• Get real: Encourage staff to share real-life cases to talk through during meetings and as they are happening. Holding a discussion on scenarios or challenges one clinician encounters may assist others in understanding the application of OASIS-E guidance.
• Review, Review, Review: Monitor documentation to ensure accuracy and consistency. Quick turnaround of feedback reduces and prevents continued errors and the formation of bad habits.
• Collaborate: Whether it is a discussion between nurses or an interdisciplinary team review, the clinician completing OASIS-E should have input from all staff that has contact with the patient during the assessment time frame.

Partner with a Healthcare Consulting Firm for OASIS-E Support

Ensuring your staff has the resources and full support to correctly assess and code OASIS items is critical to ensuring a smooth transition to the new data set. If your organization is overwhelmed or does not have the capacity to provide the vital resources related to OASIS-E, partnering with a healthcare consulting firm is an excellent way to keep your organization on track.