Home Health & Hospice Week

Home health clinicians are three months into OASIS-D, but plenty of trouble spots remain in the revamped patient assessment tool that took effect Jan. 1.

For example: Differences in coding M1800- series questions and the new Section GG (Functional Abilities and Goals) items are among the biggest areas of concern for home health agencies and their OASIS staff, they report. And “the issue that seems to be giving many clinicians concern is how to apply the principle of ‘safely’ to answering the new items,” says consultant Pam Warmack with Clinic Connections in Ruston, Louisiana.

“This question was posed to [the Centers for Medicare & Medicaid Services], but their response was vague and repetitive,” Warmack tells Eli. And no further guidance on this area came in the Home Health Quality Reporting Program in-person training event March 5 and 6, attendees report.

In both the March training and the OASIS-D Guidance Manual, CMS reiterates that “patients should be allowed to perform activities as indepen­dently as possible, as long as they are safe.”

And CMS gives general advice, such as this response-specific instruction for GG170Q (Does the Patient Use a Wheelchair/Scooter) reviewed at the training event: “Use clinical judgment to determine if the patient’s use of a wheelchair is for self-mobilization due to the patient’s medical condition or safety.”

The result: “Basically, clinicians are having to simply use their best judgment in answering these items,” Warmack concludes.

Some new materials regarding OASIS-D released in conjunction with the training event might be helpful in other areas, however. The new resources include:

• An updated Q&A set at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Downloads/November-2018-HH-QRP-Provider-Training-Q-and-A-Part-2.pdf. The set “is an update to the Q+A document posted on December 4, 2018, and includes responses to questions that required additional research,” CMS says on its website.
• A two-page “Understanding OASIS Function M & GG Item Coding” fact sheet at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Downloads/Understanding-OASIS-Function-M-GG-Item-Coding_Fact-Sheet.pdf. The sheet points out that “the intention is not for the codes on the GG and M items to be duplicative or always ‘match.’ Each OASIS item should be considered individually and coded based on guidance specific to that item.” (See examples of this concept, Eli’s HCW, Vol. XXVIII, No. 5.)

Remember: The M and GG items “don’t cross over completely, even though the items may appear similar,” warns Sherri Parson with Quality in Real Time in Floral Park, New York.

• A decision tree to help determine the correct code level, from 1 to 6, for the GG items at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/IRF-Quality-Reporting/Downloads/GG-Self-Care-and-Mobility-Activities-Decision-Tree.pdf.
• The training materials, mostly slide presen­tations, from the March 5 and 6 training event in the “Downloads” section at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Home-Health-Quality-Reporting-Training.html.