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1 Insights: OASIS C Skills Assessment Testing March 2012 Presenters: Rhonda Will, RN, BS, COS C, HCS D Assistant Director, OASIS Competency Institute Jean Ellis, RN Director, OASIS Competency Institute 300+ Agencies in 43 States Range of Scores % 78% 7 36% Sept Dec March % 21% High Low Average 1
2 Score by Discipline 9 89% 88% 86% 84% 86% 84% 87% 85% 84% 82% 81% 79% 79% 79% 78% 79% Sept Dec % 76% March % 74% 72% 7 68% Auditor RN Therapist Manager Other 1. Q43, (M2030)*: Management of Injectable Medications: Patient's current ability to prepare and take all prescribed injectable medications reliably and safely 28% of all testers responded correctly Auditors 55% correct Managers 47% correct RNs 24% correct Therapists 25% correct Other 44% correct *Appeared as a bonus question in December Q41, (M1910): Do these results indicate a high risk for falls? 31% of all testers responded correctly COMPARISON BETWEEN TESTING QUARTERS Q41, (M1910) March 2012 December 2011 Overall 31% correct 15% correct Auditor 54% correct 32% correct RN 27% correct 13% correct Therapist 29% correct 14% correct Manager 53% correct 28% correct Other 41% correct 17% correct 2
3 3. Q42, (M1910): Has this patient had a multi factor Fall Risk Assessment? of all testers responded correctly Auditors 57% correct Managers 54% correct RNs 27% correct Therapists 29% correct Other correct 4. Q47, (M2200): Therapy Need: In the home health plan of care for the Medicare payment episode for which this assessment will define a case mix group, what is the indicated need for therapy visits? 54% of all testers responded correctly COMPARISON BETWEEN TESTING QUARTERS Q47, (M2200) March 2012 December 2011 Overall 54% correct 44% correct Auditor 77% correct 72% correct RN 47% correct 38% correct Therapist 61% correct correct Manager 7 correct 67% correct Other 58% correct 56% correct 5. Q18, (M1720): When Anxious (Reported or Observed Within the Last 14 Days) 54% of all testers responded correctly Auditors 72% correct Managers 69% correct RNs 51% correct Therapists 54% correct Other 61% correct 7 3
4 Q18 scenario (S7) Mrs. Smithfield has been diagnosed with expressive and receptive aphasia resulting from her stroke 45 days ago. She becomes tearful many times during your assessment and her caregiver reports she cries often during the day and night. The new anti depressant was started this morning. You attempt to administer the PHQ 2 Depression Screening and assess for confusion and anxiety; however, Mrs. Smithfield s only verbalizations are nonsensical and repetitive. Her caregiver is new and has only known her for the past 24 hrs. Mrs. Smithfield s daughter states, I think she recognizes me, but I can t be sure. She has been like this since the stroke. Non responsive means that the patient is unable to respond or the patient responds in a way that you can t make a clinical judgment about the patient s level of orientation. OASIS C Guidance Manual December 2011 Chapter 3: J 2 Centers for Medicare & Medicaid Services. 6. Q48, (M2200): The best response for Therapy Need 55% of all testers responded correctly Auditors 7 correct Managers 72% correct RNs 52% correct Therapists 56% correct Other 57% correct 7 7. Q22, (M1750): Is this patient receiving Psychiatric Nursing Services at home provided by a qualified psychiatric nurse? 56% of all testers responded correctly Auditors 7 correct Managers 67% correct RNs 54% correct Therapists 54% correct Other 65% correct 7 4
5 8. Q30, (M1030): Therapies the patient receives at home 56% of all testers responded correctly Auditors 7 correct Managers 71% correct RNs 58% correct Therapists 48% correct Other 64% correct 7 9. Q11, (M1032): Which of the following signs or symptoms characterize this patient as at risk for hospitalization? 62% of all testers responded correctly Auditors 56% correct Managers 68% correct RNs 61% correct Therapists 64% correct Other 68% correct Q39, (M1870): Current ability to feed self meals and snacks safely 63% of all testers responded correctly Auditors 73% correct Managers 76% correct RNs 59% correct Therapists 7 correct Other 59% correct 7 5
6 Additional Comparisons Between Testing Quarters: March 2012 & December 2011 Comparison Between Testing Quarters Q35, (M1730)*: Depression Screening: How do you score this situation using the PHQ 2 depression screening tool? 72% of all testers responded correctly Auditors 83% correct Managers 86% correct RNs 81% correct Therapists 84% correct Other 83% correct 87% 86% 85% 84% 83% 82% 81% 79% 78% *Appeared as a bonus question in December Comparison Between Testing Quarters Q36, (M1730): Depression Screening: Has the patient been screened for depression using a standardized depression screening tool? 72% of all testers responded correctly COMPARISON BETWEEN TESTING QUARTERS Q36, (M1730) March 2012 December 2011 Overall 72% correct 48% correct Auditor 77% correct correct RN 69% correct 45% correct Therapist 75% correct correct Manager 84% correct correct Other 71% correct 42% correct 6
7 Re Scored Questions Re Scored Questions Q13. (M1036): Risk Factors, either present or past, likely to affect current health status and, or outcome 21% responded incorrectly Issue: Initially, credit was not given for the response A. smoking. Action: We re scored this item to provide partial credit for response A. smoking as well as response B. obesity. Re Scored Questions Q20. (M1740): Cognitive, behavioral, and psychiatric symptoms that are demonstrated at least once a week (Reported or Observed) (Q) 9% responded incorrectly Issue: Initially, question #20 (a multiple answer question) was scored as all or nothing. A. Memory deficit B. Impaired decision making C. Verbal disruption Action: We adjusted this to apply partial credit (cumulative) for each correct response. 7
8 What Do the Results Mean for Your Agency? Implications: Quality of care Payment Future decision making by CMS Opportunities for learning Is learning occurring? Are testers the same clinicians or different ones? Is there follow up? Your Reports Your Reports 8
9 Your Reports Next Testing Session Important Dates: Week of May 7 th : Fazzi Associates will send a reminder of upcoming test May 14 th : Fazzi Associates will send spreadsheets for managers to update and return by June 1st Testing begins: Monday, June 11, 2012 Testing ends: Friday, June 29, 2012 testing@fazzi.com
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