Home Health & Hospice Week

HHAs will greet ambulations, prognosis changes with open arms.

Getting used to an entirely revised OASIS tool may take a lot of work, but at least it will come with some big improvements in troublesome M0 items.

Home health agencies should receive the changes to existing OASIS items "with jubilation," predicts consultant Judy Adams with Charlotte, NC-based LarsonAllen. The revisions will "result in much more accurate scoring in the wound and functional M0 items," Adams judges.

Many of the revisions were recommended by the OASIS Technical Expert Panel that the Centers for Medicare & Medicaid Services convened, Adams points out.

The functional item on ambulation will be one of the most celebrated changes, experts forecast. The new M0702 "at long last provides an opportunity to show improvement for those patients that make significant progress moving from a more restrictive assistive device to a less restrictive device," Adams cheers.

Old way: The current M0700 asks about ambulation and offers responses that proceed from walking with an assistive device (1) to walking with a person's assistance (2).

New way: The draft M0702 would offer a response for walking with a cane (1), walker or crutches (2) and then assistance (3).

"We needed the questions that would allow us to show how our patients improved," praises consultant Pam Warmack with Clinic Connections in Ruston, LA.

Not enough: But there are more improvements possible in the ambulation M0 item, argues OASIS consultant Linda Krulish with OASIS Answers in Redmond, WA. Krulish would like to see CMS change the responses from "cane" and "walker or crutches" to "unilateral" and "bilateral."

"As is, it would be unclear to me what to mark if my patient used two canes, ... a single crutch, or a hemiwalker," Krulish notes.

In fact, CMS makes welcome changes in all the activities of daily living (ADL) functional questions, including cutting the column on "prior" status from the questions. "The new items appear to better target the information that we all really care about," says Chicago-based consultant Rebecca Friedman Zuber.

Other critical OASIS changes include:

• Prognosis. CMS will revamp the prognosis M0 item to make it easier for clinicians to answer accurately. The new M0285 (Stability Prognosis) now would ask "Would you be surprised if this patient were to die in the next 12 months?" with yes or no response options.

That's a change from the current M0280, which merely asks whether life expectancy is greater than six months (0) or fewer than six months (1). The revised tool cuts M0260 (Overall Prognosis) altogether.

The new wording "will greatly alleviate clinicians' anxiety when answering M0280," Warmack expects. "Despite the users manual instructions for M0280, I encountered many, many nurses who had difficulty answering M0280 as less than six months."

Bottom line: The new M0 item should be easier for the clinician to answer honestly, Warmack says.

• Transferring and bathing. The new M0 item on transferring, M0692, would emphasize that it measures ability to "SAFELY" transfer and no longer would include shower and tub transferring.

Likewise, the new M0672 (Bathing) item also includes the "SAFELY" qualifier and specifies that it includes getting in and out of the shower or tub.

"This will correct an area of lengthy concern," Adams lauds. The choices in the bathing item have been in conflict with the directions on answering the question, she says.

• Skin lesions. HHAs will be happy to hear that CMS would ditch M0440 on whether the patient has a skin lesion or wound. "The definition of skin lesion or wound is so broad that the answer 'no' should not have even been an option at M0440--at least not for the geriatric patient," Warmack observes.

CMS would add a new item on lesions, M0489, which would ask about only lesions that are receiving clinical intervention.

Reminder: Don't celebrate the proposed changes just yet. CMS still has to test the revised tool, incorporate changes, propose a final version and then finalize that version. A lot could change between this draft and the final adopted tool.

Note: To receive a copy of the draft OASIS tool CMS is proposing to test this fall, email editor Rebecca Johnson at rebeccaj@eliresearch.com with "OASIS Revamp" in the subject line.