Home Health & Hospice Week

CMS significantly revamped OASIS-C in response to field testing.

A whole new OASIS world is coming in 2010 -- and you'll need to start preparing sooner than you think.

This month, the Centers for Medicare & Medicaid Services plans to issue a new version of the OASIS-C tool that it has significantly revised based on industry comment and field testing, said CMS's Debora Terkay at the National Association for Home Care & Hospice's annual meeting Oct. 14.

Implementation of the new assessment tool is slated for January 2010, said Angela Richard with OASIS contractor University of Colorado Health Sciences Center.

CMS field tested the new OASIS-C in 11 home health agencies in Colorado, Massachusetts, and Ohio, noted Elizabeth Madigan with OASIS contractor Case Western Reserve University. Three to five clinicians at each agency tested the tool at various time points.

CMS was careful to choose a mix of provider types such as hospital-based, freestanding, and non-profits and a mix of locations ranging from frontier to urban, Madigan explained in a packed session at the conference in Ft. Lauderdale, Fla. The agency also made sure that physical therapists completed assessments.

One major purpose of the field testing was to determine which items needed revisions. "If you ask home care folks what they think, they'll tell ya," Madigan joked.

CMS significantly revised the tool based on testers' feedback, noted Deborah Deitz with Abt Associates, another OASIS contractor.

Example: CMS and its contractors revised the new item on drug education (M1180 on the originally proposed OASIS-C form). The item will now indicate that clinicians don't have to teach every drug on the first visit. Instead, they can prioritize the high-risk drugs, Deitz said.

They also revamped the item on the Pneum-ococcal Vaccine (M1031), Deitz revealed. Instead of asking if the vaccination is "up to date," the new tool will just ask if the patient has ever received the PPV, she explained. That's because determining whether the status is up to date can be complicated.

The tool will also ask about vaccinations at discharge instead of admission, Deitz added.

A number of changes CMS proposed last year will remain in the tool. For example, the new item on ambulation (M0702) will differentiate between walking with a cane and walking with crutches or a walker, Deitz noted. Attendees cheered this long-desired revision.

Other changes Deitz noted include:

• Activities of daily living (ADLs) will now specify that they must be performed "safely;"

• Medication questions will now ask about 100 percent of a patient's time instead of 50 percent;

• The "prior status" column for ADLs is gone; and

• The prognosis question about death within six months has been replaced with two items on frailty and stability that have more options. Those were well received by field testers, Deitz observed.

Along with welcome changes are ones agencies aren't so sure about. CMS will require data collection on a new batch of process-based measures, Deitz noted. Those include questions on topics like pain, ulcers, heart failure, and diabetes that cover assessment, interventions, and care planning.

More process measures require a depression screen and fall risk screen for all patients.

HHAs like process measures because they have more control over them than patient outcomes, one conference attendee told Eli.

And some testers were happy to "get credit" on OASIS-C for things they already do, like conducting a Braden scale for pressure ulcer risk assessment, Deitz noted.

But the process measure questions will add a significant time burden to OASIS data collection, experts note.

New guidance: Along with the new tool will come new Chapter 8 guidance, which advises HHAs with OASIS item tips, Madigan advised.

And expect even more changes to the OASIS-C tool after it undergoes another round of public comments, the presenters stressed. After CMS issues the revised form in the Federal Reg-ister, it will take comments and incorporate them into the final product due out next year.

CMS will conduct education and training on the new tool once it is finalized, Terkay noted.

Note: Sign up for Rebecca Friedman Zu-ber's Nov. 19 Eli-sponsored audioconference, "OA-SIS-C: What You Need To Know Now About This Ma-jor Assessment Overhaul," at http://www.audioeducator.com/industry_conference.php?id=1306 or by calling 1-800-508-2582.