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OASIS Alert

Reimbursement:

CONTINUOUS OR INTERMITTENT ASSISTANCE THATS THE M0670 KEY

Published on Tue Apr 01, 2003

Ask not if the patient bathes herself ask if she bathes herself safely.

OASIS item M0670 asks clinicians to evaluate a patient's ability to bathe safely. This item affects reimbursement by adding eight points for answering 2, 3, 4 or 5.

It also is one of the three items the Centers for Medicare & Medicaid Services plans to publicize as part of its Home Care Compare project (see article 4). "Agencies need to give some special attention to this item," advises Chapel Hill, NC-based consultant Judy Adams with the LarsonAllen Health Care Group.

Consistency within your agency in answering this question can make your future outcomes much more accurate, according to consultant Linda Krulish with Redmond, WA-based HomeTherapy Services. Many patients will be either a 2 or 3 (needing some type of assistance) but if clinicians don't interpret these answers the same way, the patient may look like she's deteriorated when she hasn't. Or you may not get credit for her improvement, she adds.

To ensure accuracy, experts suggest you:

  • Cut through wordiness. "The answers to M0670 are wordy and confusing, and may make the question look more complicated than it is," Krulish warns. Don't let the excess text distract you. The similarity to M0690 also confuses people, she notes. It might seem like you're answering the same question twice, but M0690 only addresses the patient's ability to transfer into and out of the tub or shower, while M0670 asks about the entire bathing process.

    Many questions arise as clinicians try to choose between answers 2 and 3, Krulish reports. For both answers the patient needs some assistance, but the key is whether the assistance is continuous or intermittent, she explains. If the person assisting the patient can leave the room while the patient bathes and the patient would still be safe, you would choose 2, Krulish advises. If not, choose 3.

  • Emphasize safety. "Patients may be marginally able to bathe in the tub or shower, but are not safe to do so unless someone is present to assist them," Adams stresses. The key question is how much assistance a patient needs to bathe safely, she adds.

    M0670 doesn't ask if the patient bathes herself, Krulish emphasizes, it asks what the patient needs to bathe safely. Observe whether the strategies the patient uses to get in and out of the tub are safe. Note if the patient is too lethargic to bathe safely alone.

    And don't worry if the assistance isn't "hands on," Krulish says. Even if the assistant never touches the patient, if the assistant must be there for the patient to feel safe bathing, the score can reflect this, she adds.

    Despite the fact that this question can add points for reimbursement, CMS has defined the term assistance very liberally, she explains. Assistance can include someone present to give verbal cues about what to do next, someone to turn on the water and adjust the temperature or even someone who is present because a frail patient is afraid she might fall.

  • Focus on possibilities. If a patient can safely take a shower, but prefers to take a sponge bath, she is not a 4 (unable to use shower or tub and is bathed in bed or bedside chair), Adams counsels. But a post-operative patient who can't use the tub or shower because she must keep the incision dry would be a 4, even if she is quite independent in taking a sponge bath, Krulish explains. That answer also would apply to someone whose home lacks a tub or shower, since the environmental barrier prevents the patient from using one, she adds.

  • Use your observation skills. The OASIS assessment hints emphasize using a combination of observation and interviewing techniques to answer this question, Adams reminds clinicians. Observing the actual transfer into the tub or shower might help identify assistive devices that could allow the patient to be more independent or safer, she adds.

    Many observations you make throughout the assessment can give you clues to the type of assistance the patient might need, Krulish suggests. For example, if the patient can't turn the doorknob, ask if she can turn on the bath water. If the patient can't comb her hair, ask if she can reach up to wash it. If the patient is unsteady ambulating, expect her ton eed assistance getting into and out of the tub.

     

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