OASIS Alert

Are you focusing too much on start of care assessments?

Pay for performance will be tied to reimbursement, so you'll need to be able to hit the road running. Improving your OASIS data is an important first step.

Proceed as if P4P is already in place, because it takes a year or more to get your act together, said Pat Heffernan with Lifetime Care in Rochester, NY, making a presentation for the New York Quality Improvement Organization IPRO. Heffernan's organization participated in IPRO's ReACH demonstration project, focused on reducing acute care hospitalization for patients with congestive heart failure.

OASIS May Be Frustrating -- But You're Going To Need It

Despite its many limitations, OASIS provides a tremendous amount of data for home care, Heffernan noted. And you can use that data to focus on outcomes you know the Centers for Medicare & Medicaid Services is interested in -- like hospitalization and emergent care.

Two for one: P4P is most likely to use established OASIS assessment measures, experts agree. That means any efforts you put into improving your OASIS accuracy will affect both Home Health Compare and P4P.

Heffernan suggested three important places agencies can focus their efforts:

1. Allow time for accurate assessments. Your OASIS database and scoring is tied to your assessment of the patient's acuity level, Heffernan said. "It's imperative that clinicians take the time to capture all that's going on with the patient," she emphasized. That's the way to be sure the scoring is accurate and the reimbursement is sufficient to cover the services you need to provide for the patient, she added.

2. Emphasize the discharge OASIS as well. The difference between the start of care OASIS assessment and the discharge or transfer assessment is what drives your Home Health Compare scores and will drive quality scores for P4P, Heffernan said. Take time to do an effective discharge OASIS so you capture the improvements the patient made, she urged.

3. Use OASIS regional and national benchmarks. Showing your staff how they compare to other agencies in your target outcomes helps motivate them to look for solutions, Heffernan reported. It will be hard to compete in P4P without a point-of-care system that allows you to look at data "in real time," she said.

Strategy: Watch the trends in weekly, monthly and quarterly segments to identify potential problems.

Can you drill down to see if clinicians are meeting expectations in OASIS accuracy, quality and outcomes? This will be extremely important under P4P, Heffernan predicted.

Note: For more information on both presentations and available resources for addressing acute care hospitalization, go to http://providers.ipro.org/index/homehealth.