By Sharon Hamilton MS, RN, NLCP-C, CFDS 2018 Briggs Healthcare

Transcription

1 By Sharon Hamilton MS, RN, NLCP-C, CFDS 1

2 Objectives Understand that OASIS D changes are based on the IMPACT Act s mandate to support interoperability between the post-acute providers electronic health records. Specifically, the assessment data and quality measure data. Understand the importance of clinicians adjusting their workflow to achieve effective productivity (good time management) Discuss the new items at Start of Care / Resumption of Care and identify the items with revised skip patterns, items that were revised and items that were removed. Know that OASIS D will implement on January 1, 2019 and will replace the current version OASIS C2. Know that a response date of January 1, 2019 or later for item M0090 Date Assessment Completed will require the use of OASIS-D. 2

3 Why OASIS-D? 1. CMS is aligning quality measurement across post-acute care (PAC) assessment instruments to meet the provisions of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of The move toward standardized assessment data items facilitates cross-setting uses for: 1. Data/information collection 2. Quality measurement 3. Outcome comparison 4. Interoperable data exchange 3. Standardized (uniform) data items are nested within the assessment instruments currently required for submission from the LTCH, IRF, SNF, and HHA providers. 4. Development and reporting of measures pertaining to resource use, hospitalization, and discharge to the community. 5. Development and implementation of quality measures from five quality measure domains using standardized assessment data. 6. Enable interoperability and accessibility to longitudinal information for providers to facilitate coordinated care, improved outcomes, and overall quality comparisons.

4 Long Term Care MDS COMPARED to OASIS-D 4

5 Data Element Standardization = Interoperability Section GG will be added to OASIS for standardization and alignment with other PAC settings, including: Inpatient rehabilitation facilities (IRFs) Skilled nursing facilities (SNFs) Long-term care hospitals (LTCHs) Standardized Patient Assessment Data Elements (SPADEs) 11/8/2018 5

6 All Items Removed with the Transition from OASIS C2 to OASIS D M Date of last home visit M List inpatient diagnosis* M Medical or treatment change in past 14 days M1018 Conditions prior to medical /treatment regimen change or impatient stay within past 14 days M1025 Diagnoses, Symptom control, and optional diagnoses M1034 Overall risk M1036 Risk factors* M1210 Ability to hear* M1220 Understanding of verbal content* M1230 Speech and oral (verbal) Expression of language* M1240 Has the patient had a formal Pain Assessment using a validated tool M1300 Pressure ulcer assessment M1302 Does this patient have a risk of developing pressure ulcers M1313 Worsening in pressure ulcer status since SOC/ROC M1320 Status of most problematic pressure ulcer that is observable M1350 Does the patient have a skin lesion or open wound M1410 Respiratory treatments utilized at home* M1501 Symptoms of heart failure patients M1511 Heart failure follow-up M1615 When does urinary incontinence occur* M1750 Is this patient receiving psychiatric nursing services at home M1880 Current ability to plan and prepare light meals* M1890 Ability to use the telephone* M1900 Prior functioning ADL/IADL* M2040 Prior medication management M2110 How often does the patient receive ADL or IADL assistance M2250 Plan of care synopsis* M2430 Reason for hospitalization *Content put back into the OASIS form as Briggs Value Ad 6

7 All Items Revised with the Transition from OASIS C2 to OASIS D

8 All Items Revised Skip Patterns with the Transition from OASIS C2 to OASIS D

9 New GG Items and Item Sets Added to The SOC/ROC When Transitioning From OASIS C2 to OASIS D Functional Abilities and Goals GG0100 Prior Functioning GG0110 Prior Device Use GG0130 Self-Care GG0170 Mobility (changed from GG0170C) DATA ELEMENT LIBRARY 9

10 Skilled Nursing SOC/ROC 3491P-19 Some items allow a dash response. A dash ( ) value indicates that no information is available. CMS expects dash use to be a rare occurrence. Item Uses reason for analyzing or using the data Primary and Secondary Physician (484.60(d)(1) G602) Including the Primary Practitioner /Practitioner s Group post-discharge (484.60(c)(3)(ii) G598) Physician ordered ROC (484.55(d)(2) G548) Fixed 48-hours post 24-hours hospitalization Emergency Preparedness ( ) Priority Code Name of contact person with relationship and contact information 11/8/

11 Upper right hand corner, document information about the patient s representative (if any) (484.60(d)(4) G608) (484.60(e) G612) Briggs Tip: information about the One Clinician Convention. For further information go to: Initiatives-Patient-Assessment- Instruments/HomeHealthQualityInits/Downloads/Ho me-health-oasis-april-2018-quarterly-qas.pdf 11/8/

12 Primary reason for home health. /medicare-home-health-benefitsface-to-face-encounterrequirement/ Certifying Physician s Prognosis (484.60(a)(2) G574) Determining Medicare home health eligibility including homebound status ( G510) (484.55(a)(1)G514) and therapy only (484.55(b)(3)G524) NOTE: Briggs Value Ad provides a place to document prior pertinent history, immunizations and hospitalizations. Covers the removal of M /8/

13 M1021/M1023 no longer has the M1025 Optional Diagnoses column (a)(2) G574 The individualized plan of care must include all pertinent diagnoses. 11/8/

14 M1036 was removed but the information is still needed. At various places throughout the form you will see information that assesses risk. 11/8/

15 M1900 Prior Function was removed and an abbreviated version was added back. The value ad is generalized compared to the original item. M1210 was removed and added back as value ad. 11/8/

16 M1220 and M1230 were both removed and added back in as value ad. 11/8/

17 The definitions for the Ulcer/Injury Stages were updated to include the National Pressure Ulcer Advisory Panel (NPUAP) definitions. 17

18 M1410 was removed and replaced as value ad. M1036 was removed but the information is still needed. At various places throughout the form you will see information that assesses risk. 11/8/

19 M1615 was removed and replaced as value ad. 11/8/

20 Refresher - Usual Performance and Assessment Timeframe Understand the time period under consideration for each item. Report what is true on the day of assessment unless a different time period has been indicated in the item or related guidance. Day of assessment is defined as the 24 hours immediately preceding the home visit and the time spent by the clinician in the home. (1) SOC - The comprehensive assessment must be completed in a timely manner, consistent with the patient s immediate needs, but no later than 5 calendar days after the start of care. (2) ROC - 2 days of facility discharge date or knowledge of patient s return home; or on physician ordered resumption date (Effective 1/13/18)

21 Briggs Tip This information can be found in the OASIS Guidance Manual Chapter 3 Section GG Functional Abilities and Goals. Usual performance, ability is his/her ability greater than 50% of the assessment timeframe. This item gives you a snapshot of their prior ability 11/8/

22 Coding GG

23 Coding GG

24 M1880 Current ability to plan and prepare light meals was removed. M1890 Ability to use the telephone. Both were removed and replaced as value ad. 11/8/

25 11/8/

26 Licensed clinicians may assess performance based on the direct observation (preferred), interviewing patient / family and/or caregivers and through collaboration with other clinicians. Use a multidisciplinary approach when possible. The functional status is a report of the patient s baseline functional assessment. It should be provided prior to any therapy services, because therapy intervention(s) can change the accuracy of the baseline. Code for usual performance (What is true >50% of the time, not best/worst performance) NOTE: The patient is being discharged from the agency back into the community, not to an impatient facility. 11/8/

27 Discharge Coding and the Individualized Plan of Care Licensed clinicians can establish a patient s discharge goal(s) at the time of SOC/ROC based on: Patient s prior medical condition SOC/ROC performance assessment Self-care and mobility status Discussions with the patient/family Professional judgement Profession s practice standards Expected treatments Patient motivation to improve Anticipated length of stay The discharge plan 27

28 Summary Tips for GG0130 and GG0170 The assessment should be provided prior to the start of therapy services, because therapy interventions can change the accuracy of the baseline status. Use the same 6-point scale for coding when an activity was attempted. When an activity is not attempted use the same codes 7, 9, 10 or 88 depending upon the circumstance. A dash is permissible for any remaining mobility goals not coded. You have the full Assessment timeframe to complete the coding, which again means you might consider the multidiscipline approach. Just remember that the one clinician convention states the collaborating healthcare providers must have had direct contact with the patient and in this case it would have had to have happened within the assessment timeframe. You should always allow the patient to perform the activities as independently as possible, with or without a device, as long as they appear to be safe. The coding is based on the patient usual performance (what is true > than 50% of the time). Take into consideration that the patient s ability can be impacted by the environment or situations encountered in the home. A discharge code can be the same, higher or lower than the SOC/ROC performance code. If an activity is not attempted at SOC/ROC it doesn t mean you can t coded for discharge planning purposes using the 6-point scale. When coding for the discharge goals try to show in your documentation that you are thinking about the CoPs by including the patient and all stake holders input in the development of the plan of care. 11/8/

29 M2250 was removed from the OASIS-D data set. M2401 is still on the transfer-care summary and the discharge from agency- not to an inpatient facility. It s the same stuff! 29

30 Decision Tree with GG0130 and GG

31 Decision Tree continued 31

32 BRIGGS BREAKING NEWS! Briggs Healthcare Acquires Selman-Holman & Associates to Expand Home Health Compliance Portfolio Simplify Your Paper-to-Digital Transition & Break Through Interoperability Barriers with ebriggs Powered by PilotFish Questions and Thank You for Attending 32