Home Health & Hospice Week

Even if home health agencies are sure that dropping private-pay OASIS data collection is officially sanctioned, many aren't jumping to make it happen immediately.

The decision to abandon OASIS for private-pay patients isn't an easy one. "I never rush into anything," says Beth Simmons, director of professional services for the VNA of Florida headquartered in Stuart. "We have not yet stopped gathering the OASIS data on our Non-Medicare/Medicaid patients, but are seriously considering doing so in the future," Simmons tells Eli.

Why You Should Dump OASIS For Private-Pay Patients..... 

"Everybody was very, very happy" to hear the private-pay requirement had finally been lifted after years of protest, says Joie Glenn of the New Mexico Association for Home and Hospice Care. Some folks vowed to discontinue the collection "right now." Some Associated Home Health Industries of Florida members have made the same decision, reports AHHIF's Gene Tischer.

Many providers see the announcement as a golden opportunity to do less paperwork and more patient care, says Mary St. Pierre with the National Association for Home Care & Hospice. They can find their assessments from pre-OASIS days to make the change easily, she points out.

Some in the industry see OASIS as a paperwork burden "taking nurses too much time from clinical intervention in home health," says Bob Wardwell with the Visiting Nurse Associations of America. "Wasted time on OASIS could actually have the perverse effect of reducing quality."

Just the data entry and other administrative duties surrounding the collection "require more staff time and back office time," Simmons notes. "It definitely adds to our costs," especially for typically low-paying insurance patients.

It may take more than three or four insurance visits to even cover the costs of collecting OASIS on the first visit, says Jean MacDonald with the Indiana Association for Home and Hospice Care. And insurance patients whom the HHA will see only a few times resent the invasion of privacy and time involved in completing OASIS, Mac-Donald maintains.

Scrapping OASIS and using a "mini comprehensive assessment" for insurance patients will be "a real money-saving issue" for agencies, MacDonald predicts. HHAs should remember the conditions of participation do require a comprehensive assessment for every patient, regardless of OASIS status, she adds.

Another reason to dump the collection is that many of the OASIS questions aren't relevant to the younger, less frail individuals needing just a few visits paid for by insurance, Simmons points out. "With OASIS rules, there is no flexibility," she says.

And those very short lengths of stay generally don't support the VNA's quality improvement via outcomes, because it's too little time to see improvements or declines, Simmons adds.

While the change isn't a cure-all, it will give agencies help, Glenn judges. "Any relief is good."

.....And Why You Should Keep It 

AHHIF members have told Tischer the OASIS items are too well incorporated into their comprehensive assessments to extract them easily. Because they don't want to have two different sets of assessments - one for government-paid patients and one for privately paid ones - the members are going to continue to collect the data.

Agencies with electronic systems will have to evaluate carefully whether it's worth the system changes to separate the non-government-paid patients out from the rest for OASIS, MacDonald says.

An HHA that called into the Nov. 5 forum cited similar concerns. The agency had "so embedded OASIS into assessments" that it was going to take a lot of work to pull it out, the caller said.

Centers for Medicare & Medicaid Services Administrator Tom Scully urged the agency not to knock itself out shedding the OASIS data. Instead, he recommended such agencies continue to collect it and use it for their own benefit, especially QI efforts.

And Scully emphasized that if CMS can figure out a way to use the data meaningfully, it could reimpose the requirement to collect the data on very short notice, possibly 30 days. If agencies make huge efforts to take OASIS out of their systems and train staff accordingly, they might find a short time later they just have to reinstate it all.