OASIS Alert

Say goodbye to 5 OASIS items come October.

The ICD-10 transition isn’t the only big change effective Oct. 1. You’ll also start using the OASIS-C1 on that same date. Make sure you know your way around the new OASIS, including the risk of hospitalization item, before Oct. 1 arrives.

Why change? The biggest reason for the transition to OASIS-C1 is to accommodate seven-character ICD-10 codes, said Judy Adams, RN, BSN, HCS-D, HCS-O, with Adams Home Care Consulting in Asheville, N.C.

But the Centers for Medicare& Medicaid Services took the opportunity to make some additional revisions to the OASIS form. These changes include updating clinical concepts and modifying item wording and response categories to improve item clarity, Adams said in the Eli-sponsored audioconference OASIS-C1 Changes.

Watch for: Wording changes in 44 OASIS items aim to make the language clearer. Expect more straightforward directions and response options and more specific data collection periods. You can also say goodbye to confusing abbreviations, as “for example” replaces “e.g.” and “specifically” takes the place of “i.e.” throughout the OASIS.

CMS also revised many response items to be consistent with information contained in the OASIS-C Guidance Manual.

Bid Farewell to Inpatient Procedures, Pressure Ulcer Items

The OASIS-C1 removes five items at all time points. The data currently gathered by these items isn’t used for payment, quality, or risk adjustment, Adams said. They include:

• M1012 — Inpatient Procedures. Since April 2011, CMS hasn’t required home health agencies to list a procedure code for this once time-consuming item. But, under OASIS-C you must respond “NA” or “Unknown.” With OASIS-C1, the item is completely removed.
• M1310, M1312, and M1314 which report the length, width, and depth of the pressure ulcer with the largest surface dimension. The intent of these items was to show whether a pressure ulcer improved, but they didn’t always track the same ulcer from one OASIS to the next, so the items weren’t as useful as hoped, Adams said. These items aren’t included on OASIS-C1.
• M2440 — For what Reason(s) was the patient Admitted to a Nursing Home? is also slated for removal from the OASIS-C1 data set.

While many familiar items will undergo minor changes in OASIS-C1, the risk for hospitalization item will see a more extensive makeover.

Currently, M1032 — Risk for Hospitalization asks “Which of the following signs or symptoms characterize this patient as at risk for hospitalization?” Your options include

1 — Recent decline in mental, emotional, or behavioral status
2 — Multiple hospitalizations (2 or more) in the past 12 months
3 — History of falls (2 or more falls — or any fall with an injury — in the past year)
4 — Taking five or more medications
5 — Frailty indicators, e.g., weight loss, self-reported exhaustion
6 — Other
7 — None of the above

In OASIS-C1, M1032 will change to M1033 and your response options expand to the following (new or changed items in italics):

1 — History of falls (2 or more falls — or any fall with an injury — in the past 12 months)
2 — Unintentional weight loss of a total of 10 pounds or more in the past 12 months
3 — Multiple hospitalizations (2 or more) in the past 6 months
4 — Multiple emergency department visits (2 or more) in the past 6 months
5 — Decline in mental, emotional, or behavioral status in the past 3 months
6 — Reported or observed history of difficulty complying with any medical instructions (for example, medications, diet, exercise) in the past 3 months
7 — Currently taking 5 or more medications
8 — Currently reports exhaustion
9 — Other risk(s) not listed in 1-8
10 — None of the above

Item M1033 will provide greater definition of the appropriate look-back period for these hospitalization risk factors, Adams said. The item will include additional risk factors for hospitalization predictors that aren’t currently on the OASIS, she said.

What hasn’t changed? You can still check all of the M1033 responses that apply for your patient.

Note: Watch for more details on changed OASIS-C1 items in upcoming issues of Eli’s OASIS Alert. To order a CD or transcript of Adams’ audioconference, visit www.audioeducator.com/home-health/oasis-c-1-2014-01-22-14.html.