Home Health & Hospice Week

Don't make the mistake of thinking your hard OASIS C work is over now that the Jan. 1 implementation date has passed -- it's only just starting.

Heed this advice from OASIS experts to safeguard your reimbursement, outcomes, and compliance record in the first weeks of the transition to the new assessment tool:

1. Review OASIS. Now's the time to see how your OASIS C staff training is paying off. Review everyone's OASIS assessments, advises consultant Laura Gramenelles with Simione Consultantsin Westborough, Mass. Don't exempt your most skilled clinicians from a thorough OASIS review, Gramenelles cautions. "They're startingover," she points out.

"Managers and QI people should be reviewing the OASIS assessments for completeness and consistency," recommends Judy Adams with Adams Home Care Consulting in Chapel Hill, N.C. "With all of the changes ... there will likely be issues, especially when using the OASIS C for existing patients."

2. Zero in on hot spots. Your OASIS reviews should home in on areas that are likely to trouble clinicians, experts advise. For example, wound items will be a major area prone to errors, predicts physical therapist Cindy Krafft with Fazzi Associates in Northampton, Mass. "With so much confusion and angst, this one will need priority attention," Krafft tells Eli.

New OASIS C item M1308 (Current number of unhealed [non-epithelialized] pressure ulcers at each stage) is likely to be one of the trickiest new wound items, Gramenelles cautions. The follow-up and discharge columns may cause confusion.

HHAs should also focus on the "lookback" items on discharge and transfer OASIS assessments, says consultant Sharon Litwin with 5 Star Consultants in Ballwin, Mo.

A big red flag will be clinicians who answer "no" to risk assessment and intervention items when the assessment found the patient to be at risk, warns Lynda Laff with Laff Associates in Hilton HeadIsland, S.C.

On the other hand, not every process item question should be answered "yes," Adams points out. For example, when the patient isn't at risk, interventions often aren't indicated. So be sure to watch assessments for both extremes on the new process items.

And make sure physician orders match the plan of care, Laff adds. Often an IT system will include a clinical protocol, but that doesn't mean it's automatically on the plan of care. "Make sure your  clinicians understand the difference between an intervention that is documented in a protocol versus a necessary physician order that must be included in M2250 and addressed again at M2400," Laff directs. "Often clinical protocols include interventions that are also orders that should be included in the Plan of Care (485)."

You should look carefully at records for heart failure patients as well, suggests consultant Pam Warmack with Clinic Connections in Ruston, La. Make sure "nurses are responding appropriately to patients who present with symptoms of CHF."

3. Keep up your OASIS C education. Reeducation of clinicians in the coming months will be critical, experts agree. No matter how good your pre-implementation training was, clinicians will  earn the most about OASIS C once they are actually using the new items, Adams believes.

Keep sessions short and sweet -- 30 to 60 minutes tops -- and targeted at specific topics, Adams recommends.

Use the results of your OASIS reviews to stress topics that staff trip up on the most, Litwin says. You can also use staff feedback and question-and 

Good idea: Use real-life examples of errors you've found in your reviews to help educate staff, Litwin suggests.

Be sure to include all affected staff, including home health and therapy aides, in training.

Another way: You won't always need to conduct education via a big training session. You can issue periodic clarifications to top staff, who can pass them on to frontline clinicians, Adams suggests.

4. Reinforce coordination of care. Reliable OASIS data is only as good as the clinicians filling out the assessments, and the policies and procedures underlying them. "Check that there is good coordination of care between disciplines," Litwin counsels.

5. Keep an open mind. As your clinicians fill out the new OASIS tool, particularly the process measure items, you may find that you need to rearrange your procedures to facilitate data collection. Don't be afraid to change your processes based on your findings, Litwin says.

6. Test your software. If you haven't done so yet, test your software to make sure you are all systems go, says consultant Melinda Gaboury with Healthcare Provider Solutions in Nashville, Tenn. While there are no actual billing changes associated with OASIS C implementation, "there could certainly be delayed billing if software systems and personnel aren't ready to start completing the new assessments," warns consultant M. Aaron Little with BKD in Springfield, Mo.

7. Plan for future reviews. Starting in February or March, conduct "mini audits" that look for specific problem areas, Laff counsels. "Lookback" items and orders on the plan of care will likely continue to top the list of concerns.

Remember: "The educational process and revisions are an ongoing process," Adams says. sessions to direct your educational efforts.