OASIS-D will introduce new requirements to the home health industry beginning January 1, 2019.
Axxess has released OASIS-D early so clinicians can become familiar with the changes before they take effect, and organizations can prepare for a seamless transition in the new year. The below outline will guide you through OASIS-D changes in the system.
Clinicians must understand the new requirements and how to navigate changes in the system to sustain accurate, high-quality data collection using OASIS-D. Changes from OASIS-C2 to OASIS-D include the addition of six new items, removal of 28 items, updated skip patterns, and item revisions including changed response options and modified instructions. OASIS-D changes that directly impact clinicians' assessment and documentation, and thus necessitate staff training, are listed below. Exhaustive information on all the OASIS-D changes can be accessed in the OASIS-D Guidance Manual provided by CMS.
OASIS-D System Changes Overview
The OASIS-D assessment looks very similar to the previous OASIS-C2 in Axxess AgencyCore. Due to the removal of 28 items, many of the tabs contain less information. Item modifications are dispersed throughout the tabs. New items are contained in a new Functional Abilities & Goals tab.
Changes are listed below in order of the OASIS assessment progression:
Patient History & Diagnoses tab
The following items have been removed from the Patient History & Diagnoses tab:
- M1000 Inpatient Discharges (in the Past 14 Days)
- M1011 Inpatient Diagnoses (in the Past 14 Days)
- M1017 Medical or Treatment Regimen Change in Past 14 Days
- M1025 Optional Diagnoses
M1028 Active Diagnoses has been revised to include a "None of the above" response option.
Risk Assessment tab
The instructions for M1060 Height and Weight have been revised to specify that only measures assessed by the clinician during the five-day window of assessment are acceptable. Patient-reported measures are not allowed. Measures from another provider setting are not allowed.
Integumentary Status tab
To standardize the language and assessment across post-acute settings, items related to pressure ulcers (M1306, M1311, M1322, M1324) have been updated to correspond with the National Pressure Ulcer Advisory Panel (NPUAP) terminology (e.g., "Pressure Ulcer" has been updated to "Pressure Ulcer/Injury").
The response options for M1311 have been revised in the Follow-Up OASIS, and a dash is now allowed at Discharge. (Dashes are expected to be rarely used.)
In M1334, the definition of "healing status" has been updated to match the Wound Ostomy Continence Nurses (WOCN) Society standard.
Definitions for M1334:
- Fully granulating
- Wound bed filled with granulation tissue to the level of the surrounding skin; and
- No dead space; and
- No avascular tissue (eschar and/or slough); and
- No signs or symptoms of infection; and
- Wound edges are open.
- Early/partial granulation
- Wound bed covered with ≥ 25% of granulation tissue; and
- Wound bed covered with < 25% of avascular tissue (eschar and/or slough); and
- No signs or symptoms of infection; and
- Wound edges are open.
- Not healing
- Wound with ≥ 25% avascular tissue (eschar and/or slough); or
- Signs/symptoms of infection; or
- Clean but nongranulating wound bed; or
- Closed/hyperkeratotic wound edges; or
- Persistent failure to improve despite appropriate and comprehensive wound management.
Neuro/Behavioral Status tab
Items in the Neuro/Behavioral Status tab have remained the same but guidance in the tool tips has been updated. As in other assessment tabs, collaboration is allowed for completion of the Depression Screening. Another clinician may use the screening tool and report to the clinician responsible for completing the OASIS assessment. This must be done within the five-day period allowed for completing the assessment.
Functional Status tab
Collaboration is now allowed for all items in the Functional Status tab. These items assess activities of daily living (ADLs) and identify the patient's ability to safely complete each activity, with or without an assistive device.
Functional Abilities & Goals tab
All six of the new items are contained in the new Functional Abilities & Goals tab.
The first four new items assess functional abilities:
- GG0100 Prior Functioning: Everyday Activities
- GG0110 Prior Device Use
- GG0130 Self-Care
- GG0170 Mobility
These items match functional assessment items in other post-acute settings, allowing accurate comparisons of patient outcomes between home health agencies, inpatient rehabilitation facilities, skilled nursing facilities, and long-term care hospitals. The items in this tab differ from the Functional Status tab items outlined above, in that the new GG items assess how much assistance the patient needs to complete the tasks.
The Apply to All feature on this tab allows all items in a section to be completed with a single click, maximizing efficiency and ease of use, and reducing documentation time. Clinicians can choose to answer each row individually, or use the Apply to All feature. After selecting Apply to All, items can be edited individually as needed.
GG0100 Prior Functioning: Everyday Activities
Obtain this information through patient and caregiver interviews and review of clinical documentation.
GG0110 Prior Device Use
Obtain this information through patient and caregiver interviews as well as review of clinical documentation.
Assess performance and document a discharge goal at the Start of Care comprehensive assessment. At Follow-Up, assess performance on three of the seven items. At Discharge, assess performance on all seven items.
Assess performance and document a discharge goal at the Start of Care comprehensive assessment. At Follow-Up, complete only 12 of the 17 functional assessments on GG0170. At Discharge, assess performance on all 17 items.
The last two new items assess health conditions related to falls:
- J1800 Any Falls Since Start of Care or Resumption of Care
(included in the Transfer to Inpatient Facility, Death, and Discharge OASIS)
- J1900 Number of Falls Since Start of Care or Resumption of Care
(included in the Transfer to Inpatient Facility and Death OASIS)
These items correspond to fall assessment items across other post-acute care settings, allowing objective comparisons of patient outcomes.
Care Management tab
In M2102 Types and Sources of Assistance, sections A-E and G have been removed in the Start of Care OASIS. Sections B, E and G have been removed in the Discharge OASIS.
OASIS-D Start of Care:
Emergent Care tab
In the Transfer and Discharge OASIS, 15 response options have been removed from M2310, leaving four response options remaining.
A thorough assessment and accurate OASIS completion are essential to deliver high-quality, valuable home healthcare services and achieve optimal outcomes. Stay tuned as we conclude our four-part blog series on OASIS-D in an upcoming blog with consultative best practices to help you systematically prepare your organization for a successful transition to OASIS-D.