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OASIS-E implementation: An overview for home health providers

With the implementation of OASIS-E in January 2023, home health can expect big changes in clinical documentation. Learn what’s new.
clinical documentation

The Centers for Medicare & Medicaid Services’ (CMS’) OASIS-E assessment for home health will become effective in January 2023. The shift from OASIS-D1 to OASIS-E moves CMS closer to their goal of aligning all post-acute providers with one standardized assessment tool.

OASIS – a home health assessment that collects information about a home care recipient’s demographics, clinical and functional status, and service needs – was due for an upgrade. Indeed, 25% of the content in the upcoming OASIS-E assessment is new.

But this move toward a singular tool makes a notable change not only in the time to complete the assessment, but also in the volume of information with which home health clinicians must be familiar.

That’s because this restructured OASIS-E assessment contains the most significant changes since the form was first introduced in 1999. As such, it has the potential to interrupt the clinical workflows providers are used to. This shift may be difficult for some agencies, as many are still suffering from staffing shortages that began during the COVID-19 pandemic and continue to persist amid high volumes of new patient referrals and higher acuity patients.

And because OASIS data is used to calculate payments, assess patient outcomes, and help clinicians to establish a plan of care, it’s important for providers to prepare for this change in documentation.

What’s different about OASIS-E?

Among the new items, home health clinicians will have to become more familiar with:

  • The Brief Interview for Mental Status (BIMS)
  • The Confusion Assessment Method (CAM)

Although these surveys were already present in Skilled Nursing Facility (SNF) assessments, they were added to OASIS-E by CMS to help home health providers evaluate mental status and recognize delirium in their patients. This in turn will help identify potential cognitive impairment or changes in mental status when patients are admitted to home health services.

Gathering this information is a new task for home health clinicians. This regulatory requirement will allow patients to be evaluated by their providers and receive customized care related to the their specific needs. And CMS’ new form is especially important given that cognitive impairment is associated with re-hospitalization among elderly home health care patients, which can result in poorer patient outcomes.

Additionally, new social determinants of health (SDOH) and transfer of health information questions are included in the OASIS-E assessment. Many items on the OASIS-E mirror the Minimum Data Set (MDS) tool, an assessment filled out by SNFs along with other post-acute care assessments. Another inclusion was Standard Patient Assessment Data Elements (SPADE) items, which enable data collection across post-acute care settings, allowing for outcome comparison, exchangeability of data, and comparison of quality.

Looking forward with home health assessments

In the future, CMS aims to have one assessment tool used to drive how all post-acute setting providers are paid. These types of providers include:

  • Long-term care hospitals
  • Inpatient rehabilitation facilities
  • Skilled Nursing Facilities
  • Home health agencies

OASIS-E is moving CMS one step closer to the goal of standardizing post-acute care assessments of patients’ functional, medical, cognitive, and social support statuses.

Setting clinicians up for success

Because the learning curve of a new assessment will likely initially decrease OASIS clinician productivity, home health agencies should begin educating staff now for OASIS-E changes. The form will take more time for clinicians and quality assurance staff to complete until they are familiar with the new items.

To help clinicians prepare for this change, experts recommend that agencies:

  1. Have clinicians begin completing the BIMS and CAM assessments with current patients now so they are comfortable when the implementation occurs in January
  2. Use OASIS-E education containing interactive real-life scenarios and competency testing to evaluate if clinicians understand the new questions and appropriate responses
  3. Evaluate clinicians and create specific learning plans to help increase competency for those with the lowest test scores

Beware clinician burnout

Since the beginning of 2020, home health agencies have experienced increased turnover. What’s more, clinician burnout is at the highest rates seen in the industry this decade. Improved efficiencies with clinical documentation and electronic health record (EHR) workflows are paramount to keep an agency running smoothly.

Finding ways to keep the back office and the field clinicians’ EHR tasks working efficiently is critical. Streamlined processes and task automation – from intake to admission – can help clinicians focus on patient care and assist with complete clinical documentation. The OASIS-E implementation will be challenging initially, but will ultimately lead to improved collection of standardized data elements and coordination of care between providers.

For more resources on optimizing clinical workflows, click here.

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