Home Health & Hospice Week

Agencies are ringing in the new year with increased workloads.

OASIS updates always strain home health agency productivity and finances, but the combination of a significant revamp with OASIS-E and HHAs’ short staffing is hitting agencies particularly hard right now.

“Agencies have definitely reported the OASIS is taking longer to complete, which is really challenging given that most agencies are also struggling to find and maintain appropriate levels of staff,” says M. Aaron Little with FORVIS, regarding the updated tool.

“In agencies that clinicians were well trained in advance, the implementation seems to have gone far more smoothly,” observes consultant Pam Warmack with Clinic Connections in Ruston, Louisiana. “Assessing clinicians were not taken by surprise and guessing what to do,” Warmack tells AAPC. “Those who are winging it are having push back from the RNs and therapists who are doing OASIS-E now,” she adds.

But even well-trained clinicians are taking longer to complete OASIS-E, Warmack notes.

The good news is that Little hasn’t “heard a lot yet about OASIS-E in terms of any technical issues with OASIS data being accepted/not accepted by iQIES or issues with EMRs,” he says.

Of course, it’s still early, so OASIS-E problems may just not be reported yet. A state association representative calling into the Centers for Medicare & Medicaid Services’ Jan. 11 Home Health Open Door Forum asked about issues with OASIS-E not transmitting in iQIES due to discharge codes related to hospitals. A CMS official said she hadn’t heard of the problem.

Another caller asked about whether off-label uses should count toward a “yes” response for the “Indication Noted” column for N0415 (High-Risk Drug Classes: Use and Indication). The OASIS-E Guidance Manual is unclear, she indicated.

The CMS official offered no answers and asked callers to submit specific OASIS questions to CMS via email, which a few providers said they would do.

The bad news is that the OASIS workload has definitely increased, according to provider reports.

The news could be even worse, though, says Jon Erik Higginbotham, VP of business development and clinical analyst for software vendor Homecare Homebase in Dallas. Some advance estimates were putting the increased workload for OASIS-E extremely high, Higginbotham says.

Thankfully, that doesn’t appear to be the case, Higginbotham tells AAPC.

How does he know? Homecare Homebase is gathering data from its users on how long it takes to complete OASIS-E visits compared to OASIS-D visits, Higginbotham says. The data includes both visit time in the home and the time clinicians spend documenting the visit outside the home, he notes.

Beware Time-Consuming ‘Rabbit Hole’ Questions

While HCHB isn’t ready to release firm numbers until it gathers more data, the early results show that OASIS-E visit time is definitely greater than time spent for OASIS-D visits, Higginbotham relays. Once agencies have fully integrated OASIS-E, it may take up to 20 more minutes on average to complete those assessment visits, early data indicates.

Watch out: Some OASIS-E visits may become significantly longer due to “rabbit hole” questions that lead to more questions, Higginbotham cautions. Those include new items such as C0100 (Should Brief Interview for Mental Status [C0200-C0500] be Conducted?) and D0150 (Patient Mood Interview [PHQ-2 to 9]).

The new Social Determinant of Health (SDoH) items are also slowing down assessments. Home health clinicians often “are collecting this data for the first time,” highlights Higginbotham, who is also an RN.

New functional items pose an obstacle to efficiency as well. Some of the new OASIS-E functional items may duplicate questions HHAs have addressed elsewhere in their assessment process historically, now adding extra work, Higginbotham relates.

Tip: To combat this time drain, HHAs can review their agency’s entire assessment process to weed out the duplicative areas, Higginbotham advises.

Another problem agencies are seeing is related to productivity expectations, Warmack says.

HHAs that have kept their productivity value the same for assessment visits may find sloppy OASIS data as clinicians try to complete items as fast as possible, Warmack indicates.

Tip: To head off this problem, providers have told Warmack they are increasing the point value of the Start of Care and Resumption of Care assessments for an OASIS-E assessment, she relates. For example, if “currently these assessments receive 2 points towards the productivity calculations … increasing the point value to 3 points will encourage the clinicians to slow down and do a better job while not threatening their productivity expectations,” Warmack explains.

Note: Access free OASIS-E educational sessions from consulting firm SimiTree Healthcare Consulting at https://simitreehc.com/home/resources/home-health-webinars under the “OASIS-E” section.