Home Health & Hospice Week

Recording patients’ answers when they appear to lack accuracy is confusing.

As home health agencies and their staff gear up to implement OASIS-E, some are questioning the value of a certain type of new item.

“Most people I have taught … do not like the [new items] that are self-reported” by patients, relates J’non Griffin with SimiTree Healthcare Consulting.

Reminder: As part of the sweeping update to the assessment tool, the Centers for Medicare & Medicaid Services institutes these new items that are self-reported by the patient: A1005 — Ethnicity; A1010 — Race; A1110 — Language; A1250 — Transportation; B1300 — Health Literacy; and D0700 — Social Isolation.

While self-reporting ethnicity, race and language information is fairly straightforward, doing so for the health literacy and social isolation items is less so.

B1300 addressing health literacy asks “How often do you need to have someone help you when you read instructions, pamphlets, or other written material from your doctor or pharmacy.” Responses range from “0 — Never” to “4 — Always,” plus options for patients who decline to or cannot respond.

In the OASIS-E Guidance Manual, CMS defines health literacy as “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.”

The manual says that “similar to language barriers, low health literacy interferes with communication between provider and patient. Health literacy can also affect the ability for patients to understand and follow treatment plans, including medication management. Poor health literacy is linked to lower levels of knowledge of health, worse outcomes, and the receipt of fewer preventive services, higher medical costs and rates of emergency department use.”

CMS then informs clinicians that “this item is intended to be a patient self-report item” and that “no other source should be used to identify the response,” according to the manual response-specific instructions.

The problem: “Someone told me the other day this really was useless information if the patient self-reports one thing but caregiver reports the opposite,” Griffin points out.

For example: With health literacy, “how do they honor the patient statement … that they may not have an issue, but the daughter says something different?” Griffin asks. “Should they care plan this? Do they teach the daughter since she says he doesn’t understand even though the patient self-reported he had no trouble?” she continues.

These are the kinds of questions HHAs would like to see answered before OASIS-E goes live, experts say. (See other topics needing clarification in story, p. 294. flipbook)

The guidance manual does clarify what the OASIS answer should be, in one scenario at least.

“When asked how often they need help when reading the instructions provided by their doctor, the patient reports that they never need help,” CMS offers in the manual. “The patient’s son is present and shares that a family member must always accompany the patient to doctors’ visits and that the patient often needs someone to explain the written materials to them multiple times before they understand, providing examples of needing to frequently explain to the patient why they are on a special diet and why and how to take some of their medications.”

In this circumstance, the assessing clinician should code B1300, Health Literacy “as Code 0, Never,” CMS confirms. “Rationale: The patient indicated they never need help reading instructions from their doctor or pharmacist. B1300, health literacy is intended to be a patient self-report item and no other sources, including proxy/caregivers, should be used to identify the response to this item.”

Note: The OASIS-E Guidance Manual is at www.cms.gov/files/document/oasis-e-guidance-manual51622.pdf.