OASIS Alert

The days of the easily calculated OASIS points are about to end.

Don't be fooled by the similarities between the new functional OASIS items in the proposed PPS refinements and the current ones. The changes may be subtle, but they could significantly impact your payment.

What's the same: The six OASIS case mix items that make up PPS' functional domain will remain the same -- M0650/M0660 (Dressing), M0670 (Bathing), M0680 (Toileting), M0690 (Transferring) and M0700 (Ambulation).

The functional domain case mix items "stand alone as they're scored individually," explained consultant Mark Sharp in the recent Eli-sponsored audio-conference on the proposed prospective payment system refinements. Scoring each item by itself is "consistent with current environment," noted Sharp, with BKD in Springfield, MO.

What's different: But the functional domain has its share of changes too, experts point out. Point values for most case mix items have decreased, says Abilene, TX-based consultant Bobby Dusek. And the points are different based on which episode the patient is in and number of therapy visits (see box, this page).

Clinicians filling out OASIS are going to have a difficult time keeping in mind the point values of each case mix item according to which episode it is, expects consultant Melinda Gaboury with Healthcare Provider Solutions in Nashville, TN.

Example: Nurses and therapists can now look at M0650/M0660 and know that a patient receives 4 points if they check box 1, 2 or 3 in the OASIS assessment. Under the PPSproposed changes, the patient will receive anywhere from 2 to 6 points for the same answer, depending on the episode and therapy level.

And clinicians must realize the answers to the functional M0 questions affect more than the functional domain score. The clinical do-main case mix questions on diagnosis (M0230/ M0240/M0246) award points for some neurological diagnoses only when certain functional domain item scores are also present.

Example: A primary or other diagnosis of Neuro 4 (Multiple Sclerosis) garners zero case mix points alone, but as many as nine points if paired with an answer of 2 or more in M0670 or M0680 in the third or later episode. In contrast, an MS diagnosis gets a straight-up 20 points under current PPS.

Bottom line: OASIS accuracy will be more important than ever, since even straightforward case mix items have multiple reimbursement effects. 

Note: The proposed PPS rule is at www. cms.hhs.gov/HomeHealthPPS/downloads/CMS-1541-P.pdf. Case mix point values are in Table 2a.