OASIS-E ushers in the biggest changes to the OASIS data set. After the delay of the OASIS-E implementation due to the ongoing COVID-19 Public Health emergency, the Centers for Medicare and Medicaid Services (CMS) have announced that it is projected to be put into effect at the start of 2023. 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 – What’s new with OASIS-E?
The revisions on the horizon 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 Sections
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. For more information on these items and sections, please refer here: https://www.cms.gov/files/document/draft-oasis-e-all-items03122020.pdf.
Many of the current assessment items will remain with the character designation of “M” but many will be 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 current “M” items will be placed in the letter section they correspond with. For example: M1720 “When Anxious” will be located in Section C with other new cognitive items such as, the “Brief Interview Mental Screening” (BIMS) and the “Confusion Assessment Method” (CAM).
Another area of major changes are the new assessments within OASIS-E. Included in this portion will be:
- Brief Interview for Mental Status (BIMS), which will establish a cognitive baseline by testing recall and temporal orientation
- Signs and Symptoms of Delirium from the Cognitive Assessment Method (CAM) helps to 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 PHQ2 will still be present in OASIS-E, as a gateway assessment and the PHQ9 would only be completed if the PHQ2 was positive for depression. A key reminder that with any of these assessment tools, they 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.
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.
Enrich Patient Outcomes – The meaning behind significant changes within OASIS-E
The revisions to prior versions of the OASIS as well as the revisions currently proposed with OASIS-E, are all consistent with the IMPACT Act and interoperability between care settings. By having the 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 will 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.
Transfer of Health
One significant area of change will be the Transfer of Health (TOH) information item. This will represent 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 a patient when discharged. In the future, 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 the need to develop a strong process for medication reconciliation and education to mitigate complications.
Excel with OASIS-E – Your organization’s best next steps
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 guidance changes and clarifications.
Just like any new process, agencies need to provide support through OASIS-E education. This is not a quick feat amid the ever-expanding expectations of the home health field clinician. How can your organization achieve this?
Key points to consider when educating your staff on OASIS-E
- Stay ahead of the curve: The time to start preparing and educating staff is now. Engage in learning opportunities related to OASIS-E. Subscribe today to McBee to stay up to date on our latest live training opportunities related to 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 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.
Ensuring your staff has the resources and full support to correctly assess and code OASIS items will be 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 during this transitory OASIS-E learning curve, partnering with a health care consulting firm is an excellent way to keep your organization on track.
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