Embrace the OASIS-E (Part 1)
Author: Leigh Massey, RN, JD, WOCN, CHC, CHPC
Posted: August 9, 2022
The Outcome and Assessment Information Set (OASIS) is a group of standard data elements home health agencies integrate into their comprehensive assessment to collect and report quality data to the Centers for Medicare & Medicaid Services (CMS).
The OASIS Version E (OASIS – E) collection begins January 1, 2023 and is a significant reorganization of the assessment tool. According to the OASIS – E Guidance Manual, the main reason for the revision is to increase standardization across post-acute care (PAC) settings to uniformly collect social determinants of health data to enable calculation of standardized, cross setting quality measures.
Standardized assessment data elements are assessment items and response options that are harmonized across four PAC assessment instruments, and to which aligned standards and definitions apply. This change is due to the provisions of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014.
What’s new?
The OASIS – E guidance manual identifies the following changes:
- New sections and items are added
- Different time point versions of some items
- Removal of some items
- Revision of some items
- Updated skip patterns
Layout and location of items
At first look, it is noticeably clear that the look and feel of the tool has changed. This version of OASIS is a major revision to the document which resulted in its significant redesign. To align the items and guidance across the post-acute care settings, new standardized items have been added, more sections are included or renamed, and items have been reorganized within the section.
These are the new sections in OASIS – E.
The form’s reorganization now groups similar assessments together and expands them.
One important example of this is the restructuring from the OASIS – D1 section “Neuro/Emotional/Behavioral Status” containing items: M1700 Cognitive Functioning, M1710 When Confused, M1720 When Anxious, M1730 Depression Screening using the PHQ2© scale, M1740 Cognitive, behavioral, and psychiatric symptoms, and M1745 Frequency of Disruptive Behavior Symptoms. These items have been reorganized into three separate sections.
In section C – Cognitive Patterns, as seen in the graphic below. Some of the original M items remain but new items have also been added.
Section D - Mood, as seen in the graphic below, item M1730 has been retired and replaced by an expanded Mood interview. The PHQ2© is completed as in the prior version, but depending on how the patient is assessed, additional questions will be asked and a total severity score calculated.
Section E – Behavior, as seen in the graphic below, is where the original M items now reside. Neither has changed.
This change and grouping may or may not be as obvious in an electronic medical record, but the grouping of the questions into a section or subgroup should help with data collection accuracy.
New items
There are 27 new items in total. Some of these items include collection of information that will assess patient needs that may affect the care delivery and development of interventions and goals in the plan of care. Some of these items are new, others are expanded from the OASIS – D1.
- B1300 – Health Literacy
- D0700 – Social Isolation
- J0510 – Pain Effect on Sleep
- J0520 – Pain Interference with Therapy Activities
- J0530 – Pain Interference with Day-to-Day Activities
- K0520 – Nutritional Approaches
- N0415 – High risk Drug Classes: Use and Indication
- O0100 – Special Treatments, Procedures, and Programs
Reflected themes from the Conditions of Participation
General OASIS – E Item conventions have been updated to reflect some themes in the Conditions of Participation (COPs).
Collaboration
There is a change to the single assessing clinician model used in past OASIS guidance. While only the assessing clinician is responsible for accurately completing and signing a comprehensive assessment, they may collaborate to collect data for all OASIS items. The OASIS – E Guidance Manual states, “Collaboration may consider information from others such as the patient, caregivers, and other health care personnel, including the physician, pharmacist, and/or other agency staff who have had direct contact with the patient or had some other means of gathering information to contribute to the OASIS data collection.”
The interpretive guidelines for the COPs at §484.75(b)(1) Ongoing interdisciplinary assessment of the patient, state, the term “interdisciplinary” which refers to an approach to healthcare that includes a range of health service workers. “Ongoing interdisciplinary assessment” is the continual involvement of all skilled professional staff involved in a patient’s plan of care from the initial assessment through discharge, which should include periodic discussions among the team regarding the patient’s health status and recommendations for the plan of care. An interdisciplinary approach recognizes the contributions of various health care disciplines (MDs, RNs, LPN/LVN, PT, OT, SLP, MSW, HH aides) and their interactions with each other to meet the patient's needs.
Follow Through at Discharge and Transfer
The OASIS – E has new items that support the COPs standards that ensure safe and effective transition of care. §484.58 Condition of participation: Discharge planning. (b) Standard: Discharge or transfer summary content (1) The HHA must send all necessary medical information pertaining to the patient’s current course of illness and treatment, post-discharge goals of care and treatment preferences to the receiving facility or health care practitioner to ensure the safe and effective transition of care.
New items A2120, A2121: Provision of Current Reconciled Medication List to Subsequent Provider at Transfer and Discharge to formal assistive services support the goals of the COPs. The transfer of a current reconciled medication list at the time of discharge or transfer, can improve care coordination, quality of care, help subsequent providers reconcile medications and may mitigate adverse outcomes related to medications. Communication of medication information at discharge/transfer is critical to ensure safe and effective transitions from one health care setting to another.
While the COPs also require a discharge or transfer summary, these items reflect the goals to support continuity of care.
Tips for Success
There is much to embrace! With the OASIS – E data collection beginning January 1, 2023, there is a relatively short time to prepare your agency for success. Here are some suggested next steps:
- Work with your EMR vendor as early as possible to see how changes will be reflected in your system
- Train all team members on key changes in practice and on EMR
- Include training on the new items that need to be completed; what the results mean and how to implement them into the plan of care; how they interrelate to other items and to quality outcomes
- PHQ 2-9
- BIMS
- High Risk Medications
- Medication List provided at transfer/discharge
- Pain
- Special Treatments
- Train regarding collaboration between members of the team, timelines for the collaboration and how to complete the M0090
- Audit patient records for data accuracy at all time points and integrate trends into your Performance Improvement Plan
- Consider potential policies and processes that need to be updated or implemented in your agency
For more information on how you can better prepare for OASIS-E, contact us at [email protected].
Resources:
1. OASIS – E Guidance Manual, Effective 1/1/2023, Centers for Medicare and Medicaid Services
3. State Operations Manual Appendix B - Guidance to Surveyors: Home Health Agencies (Rev. 200, 02-21-20)