OASIS Alert

6 recent Q&As clarify bathing issues.

Don't be misled by the fact that M0670 answer 2(b) mentions getting in and out of the shower or tub. 

OASIS item M0670 assesses the pa-tient's ability to bathe safely. If the patient scores 2, 3, 4 or 5, you add eight points to the functional domain of the home health resource group. Eight points moves the functional score from minimum to low--and adds more than $200 to the episode reimbursement. 

M0670 is among the wordiest M0 items, but don't make the question more complicated than it has to be, experts advise. Here's how to streamline your approach:

• Focus on safety. M0670 doesn't ask whether the patient can bathe herself. It asks how much assistance she needs to bathe herself safely, says OASIS expert Linda Krulish with Redmond, WA-based OASIS Answers Inc. Observe whether the patient is dizzy or weak. Are her strategies for bathing safe?

M0670 does not consider bath-related tasks such as turning on the water, shampooing or drying off, the Centers for Medicare & Medicaid Services says in Question 136 of the updated OASIS Q&As.

If the patient's ability on the day of assessment varies, select the response that describes her ability more than half the time (not for more than half the tasks), CMS says in the M0670 response-specific instructions and in Question 137 of the updated OASIS Q&As.

Caution: M0670 and M0690 are not duplicate questions. M0670 asks about the entire bathing process, while M0690 asks only about transferring into and out of the tub or shower. Don't consider the transfer process when answering M0670--even though response 2(b) says "Able to bathe in shower or tub with the assistance of another person to get in and out of the shower or tub," CMS says in Question 141 of the revised OASIS Q&As. If the transfer is the only bathing task the patient needs help with to safely bathe, score her "0" or "1" depending on whether she needs devices, CMS instructs.

Is Assistance Continuous or Intermittent?
 
• Understand the difference between answers "2" and "3". For both answers the patient requires assistance. The key is whether the assistance is continuous or intermittent, Krulish explains. Assistance can mean someone giving verbal cues about what to do next or just having someone present for a frail patient afraid she might fall.

If the assistant can leave the room while the patient is bathing--and the patient would still be safe-- the assistance is intermittent and you would choose "2". If not, choose "3".

Tip: The assistance doesn't need to be hands-on, Krulish notes. If the assistant needs to be present for the patient to be safe bathing--even if she never touches the patient--the score can reflect this, she says.

• Clarify between can't and won't. If the patient can safely shower but prefers a sponge bath, she is not scored a "4" (Unable to use the shower or tub and is bathed in bed or bedside chair), CMS explains. Instead, you assess how much assistance she would need to bathe in the shower and score accordingly.

But if the patient would be able to shower independently, but can't--for example because of inability to climb stairs or to because of doctor's instructions to keep a wound dry--choose response "4" or "5" (Unable to effectively participate in bathing and is totally bathed by another person), depending on the patient's ability, CMS says.

Don't miss: If the patient's home has no shower or tub or it is unsafe, this barrier keeps the patient from safely bathing in it, CMS acknowledges.
 
• Total bathing can be in the shower. If the patient is totally bathed by another person, but is transferred to a shower chair and rolled into the shower to do this, you can still score the patient "5", CMS says in OASIS Question 139.

And if the patient is unable to bathe in the tub or shower, because transfer is impossible even with equipment and assistance, you may score the patient a "4", CMS says in OASIS Question 140. Even though transfer is not included in M0670, the question is attempting to distinguish between those who are able to use the tub or shower and those who are unable, CMS says.

Don't Overlook Outcomes

You may think that making distinctions between the answers to M0670 hardly matters, because responses 2, 3, 4 and 5 all give you eight points--but think again. Besides its effect on reimbursement, M0670 is one of the outcomes that shows up on Home Health Compare. Also, a patient's OASIS scores affect your agency's case mix.

If clinicians are inconsistent in how they interpret M0670--and different clinicians do the start of care and discharge assessments--the agency's outcomes will suffer, Krulish says. For example, variation between clinicians when deciding between 2 or 3 may result in either failure to get credit for patient improvement or a patient who erroneously appears to have deteriorated.

To show improvement in bathing, the patient must progress from a higher number on admission to a lower number at discharge, CMS explains. 

Exclusion: A patient who scores "0" (Able to bathe self in shower or tub independently) is not included in CMS' calculations because she can't show improvement. Also a patient who dies at home or is transferred to an inpatient facility is not included, because a discharge OASIS is not available. 

Note: The revised Q&As are at www.qtso.com.