Home Health & Hospice Week

Make sure clinicians understand dashes.

While it’s not too late to get where you need to be on OASIS-D, you also don’t have time to waste.

Follow this expert advice to make sure your assessments — and related payments and patient outcomes — don’t suffer when the significantly revamped assessment tool hits Jan. 1:

1. Know the new tool. Familiarize yourself with the OASIS-D tool and manual. While the final versions aren’t expected until this month, they should be pretty much the same as the drafts, experts agree. (For a list of educational resources for the new assessment tool version, see box, p. 305.)

2. Revamp OASIS P&Ps. Look at the new and revised items and determine whether you’ll need to change your policies and procedures accordingly.

For example: “Some items may need alternative assessment strategies,” suggests Diane Magrady, compliance lead with Morton Grove, Illinois-based Pragma-IT, creator of the therapyBOSS therapy documentation software solution. “GG0170K requires the patient to walk 150 feet. If there is no straight 150 feet for the patient to walk without turns, the patient needs to be assessed walking 150 feet with turns.”

Another example: “Some items allow a dash response. A dash (–) value indicates that no information is available,” CMS notes in the OASISD guidance manual. However, “CMS expects dash use to be a rare occurrence,” the manual says.

Clinicians may be confused by the dash instructions. For instance, “do not use a dash if the reason that the item was not assessed was because: the patient refused (code 07); the item is not applicable (code 09); the activity was not attempted due to environmental limitations (code 10); or the activity was not attempted due to medical conditions or safety concerns (code 88),” advised Kathryn Roby and Charlotte Steniger of Qualidigm in CMS’s Sept. 5 educational session on the assessment tool.

“It would be a good idea to add use of the dash response to existing policy and procedure manuals so that there is consistent guidance about its use,” Magrady says.

3. Combine items. OASIS-D is going to add significantly to the time required to complete the assessment, expects Sherri Parson with consulting firm Quality In Real Time in Floral Park, New York. To try to minimize the additional burden as much as possible, “clinicians can develop ways to evaluate the new items with the current ADL items,” Parson recommends. This “will save some time, minimizing the time impact for the new items.” Eschew duplication: Evaluating the similar items together “will be more effective than evaluating the ADL items, and then approaching the new impact items separately,” Parson tells Eli.

4. Start training ASAP. Don’t delay in getting mandatory OASIS-D training on the books for all affected staff — but most importantly for those clinicians filling out the forms. “Get the OASIS clinicians in the office,” Magrady exhorts.

Don’t despair if you don’t have the budget for external training resources. The OASIS-D manual contains comprehensive instructions and helpful scenarios you can use to train your staff, Magrady says.

You can also tap free OASIS training that CMS has already provided or will be furnishing this month (see box, p. 305).

Education for your clinicians should focus on “comprehensive training of the items removed, additional OASIS-D items, and the different item versions for different time points,” Parson advises. “Also, implementing practical education with how to complete an evaluation combining ADL and GG items will be extremely helpful to assessing clinicians.”

In short, “go over chapter 3 of the guidance manual with an emphasis on the new questions,” Magrady counsels.

5. Lean on examples. Agencies that “want to go the extra mile [will] go over the scenarios from the manual,” Magrady adds. They can “even create a few additional ones to demonstrate how clinicians should assess patients in particular circumstances.”

6. Issue manuals. You’ll want your staff to use the new OASIS-D manual, so “provide copies of the manual as resource materials, and be available for questions,” Magrady instructs.

7. Distribute clarifications. While experts think the final version of OASIS-D and the guidance manual will remain virtually unchanged from the draft versions, there may be some small differences. Communicate any minor changes after your training via email or memo to the staff, Magrady suggests.

8. Plan some shadowing. “Consider accompanying clinicians on assessment visits prior to the end of the year,” Magrady urges. Have the staff “assess the patient using a few of the criteria as practice.”

9. Double-check. “It may be a good idea to conference with clinicians for their first couple of OASIS assessments in 2019 to be sure that they have addressed the questions appropriately,” Magrady says. Likewise, spot-check audits of assessments ongoing could head off the entrenchment of inaccurate OASIS coding.