OASIS Alert

Get up, get down, move all around — just don’t sit still if your home health agency is squandering reimbursement by allowing clinicians to inaccurately assess your patients’  transferring ability on M0690.

OASIS item M0690 (“Transferring”) is an important M00 to mull over, since certain answers can add up to six points to the case-mix score. M0690 asks clinicians to assess  their patients’ ability to move from a bed to a chair, on and off a toilet, and into and out of the tub or shower, as well as their ability to turn and position themselves in bed if they  are bedfast. According to the OASIS Implementation Manual, this M0 question is intended to identify “the patient’s ability to safely transfer in a variety of situations.”

Clinicians have six different options with which to distinguish their patient’s current transferring ability, ranging from “0” (“Able to independently transfer”) to “5” (“Bedfast,  unable to transfer and is unable to turn and position self”).

The key to acing this OASIS item is to make sure your staff fully understands what it means “to independently transfer,” instructs consultant Rose Kimball with Med-Care  Administrative Services in Dallas. “It’s not asking whether that patient has a home health aide. It’s asking what the patient’s level of independent functioning is for those  activities,” Kimball notes. “You’d be surprised at the number of people who don’t answer the question as it is intended,” she adds.

Clinicians must be certain they are answering the question honestly, states Kimball. If your patients need even a little bit of assistance — such as a hand on their elbow to  steady themselves or a quad cane to bear some of their weight — then you simply cannot label them “0” on this item, she says. Clinicians should understand that “an  assistive device is whatever the patient leans on for support, and that could mean a human or a fixed object,” informs Kimball.

HHAs need also ensure that their clinicians test patients for each of the three transferring activities listed in the question, advises consultant Pat Sevast with American  Express Tax & Business Services in Timonium, MD. “Maybe someone can get from the bed to the chair, and on and off the toilet, but they can’t get in and out of the tub.” In that  case, “they’re not really independent,” she states.

OASIS questions are very literal, counsels Sevast, which means if patients can’t independently perform all three transfers “then they need to be marked less functionally able”  for that item.

Kimball also reminds agencies that when calculating case-mix value for M0690, choices 2, 3, 4 and 5 are each worth the same six points. For scoring purposes then,  agencies really need to decide if the patient is a 0, 1, or 2 through 5, she explains. “Use your clinical judgment for 2 through 5, but realize that reimbursement rates are the same,” says Kimball.

When it comes to improving assessment accuracy for M0690, agencies should consider inter- rater teaching among nurses, physical therapists and occupational therapists, recommends Ann O’Sullivan, a family caregiver specialist with the Portland, ME-based Agency on Aging.

Therapists tend to ask patients “show me” questions, whereas nurses often pose “tell me” questions, O’Sullivan elaborates. And an OASIS item such as M0690 calls for  clinicians to observe first-hand how well their patients transfer, she continues. With inter-rater teaching, O’Sullivan explains, nurses can learn a variety of observation skills and assessment strategies from therapists who are accustomed to this “show me” type of inquiry.

When this happens, you can “get everybody on the same page as to what it means to be independent,” she says.

For example, clinicians should learn to give their patients multiple-steps commands such as asking them to get up and retrieve their medications or instructing them to take off their sweater so as to check their blood pressure, O’Sullivan reports. Such a command might allow clinicians to observe and assess movement, safety, memory and  complex processing all at once, she remarks.