2018 Conditions of Participation. OASIS-D in 2019

Transcription

1 The IMPACAT Act of 2014 & Progressing from the 2018 Conditions of Participation to the Next Big Change: OASIS-D in 2019 Sharon Hamilton MS, RN, NLCP-C, CFDS

2 OBJECTIVES Briefly explain the requirements of the IMPACT Act of 2014 Discuss how and why the standardization of the post-acute providers data (elements) is necessary to support interoperability. Identify at least two examples of past changes in the home health assessment tool, based on the IMPACT Act mandates, including the implementation of the 2018 Conditions of Participation. Compare the elements of OASIS-C2 to OASIS-D

3 The IMPACT Act of 2014 Requires 1. Standardized (uniform) data elements to be nested within the assessment instruments currently required for submission by LTCH, IRF, SNF, and HHA providers. 2. Development and reporting of measures pertaining to resource use, hospitalization, and discharge to the community. 3. Development and implementation of quality measures from five quality measure domains using standardized assessment data. 4. Enable interoperability and accessibility to longitudinal information for providers to facilitate coordinated care, improved outcomes, and overall quality comparisons.

4 Data Element Standardization = Interoperability

5 The IMPACT ACT Quality Measure Domains and Timelines Source: MLN Connects National Provider Call, Quality Measures and the IMPACT Act presentation #5 July 2016

6 Home Health Quality Measure Domain Timeline 1. Functional status, cognitive function, and changes in function and cognitive function - January 1, 2019, OASIS-D 2. Skin integrity and changes in skin integrity - January 1, 2017, OASIS-C2 3. Medication reconciliation January 1, 2017, OASIS-C2 4. Incidence of major falls January 1, 2019, OASIS-D 5. Transfer of health information and care preferences when an individual transitions January 1, 2019, OASIS-D BRIGGS COMPREHENSIVE NURSING ASSESSMENT INCLUDING SOC/ROC OASIS-C2 ELEMENTS WITH PLAN OF CARE/485 INFORMATION Item # 3491P-18

7 Examples of 2018 CoP Data Collection

8 Data Element & Response Code QI Quality Reporting Care Planning / Decision Support Payment Care Transitions

9 (a)(2) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient s mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; Source: Federal Register / Vol. 82, No. 9 / Friday, January 13, 2017 / Rules and Regulations, page 4582

10 (continued) (a)(2) The individualized plan of care must include the following: (xii) A description of the patient s risk for emergency department visits and hospital readmission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician may choose to include. Source: Federal Register / Vol. 82, No. 9 / Friday, January 13, 2017 / Rules and Regulations, page 4582

11 Examples from OASIS-C2 data elements that changed based on the IMPACT Act Example below from Briggs Care Summary # 3494P-18 Example below from Briggs Discharge Assessment # 3493P-18

12 OASIS-C2 Implementation Section GG FUNCTIONAL ABILITIES AND GOALS SOC/ROC with GG0170C

13 Comparing OASIS-C2 to the OASIS-D Including the addition of the GG and J Elements CMS will be accepting comments through May 11, 2018

14 Overview of Changes from OASIS-C2 to OASIS-D 75 data elements retired/removed SOC 75 data elements retired/removed ROC 20 data elements retired/removed Follow-up 42 data elements retired/removed Transfer 1 data element retired/removed Death at Home 34 data elements retired/removed Discharge Expanded section GG and added section J

15 Example from OASIS-D expansion of GG Section

16 GG0100 Functional Abilities and Goals OASIS-C2 Assesses patient s ability on the day of the assessment M1900 is RETIRED Prior Functioning - self-care, ambulation, transfer and household tasks. OASIS-D GG SOC/ROC Assesses patient s usual ability prior to illness, exacerbation or injury M2102 addresses the need for Supervision and safety (for example, due to cognitive impairment) Note this element has changed in OASIS-D, see next slide.

17 Use of Devices with Mobility OASIS-C2 M1880 is RETIRED 0 (b) specified prior to this home care admission. OASIS-D GG SOC/ROC Prior Device Use M1900 is RETIRED - Note, how the patient s mental and cognitive ability are assessed.

18 M2102 Care Management - Changed OASIS-C2 OASIS-D M2102 at SOC/ROC and Discharge M SOC/ROC (top) and Discharge (below)

19 OASIS-D GG0130 SOC/ROC with Discharge Goals Self-Care OASIS-C2 Ability on the day of the assessment M Feeding or Eating: Current ability to feed self meals and snacks safely. Note: This refers only to the process of eating, chewing, and swallowing, not preparing the food to be eaten. SOC/ROC D/C M Grooming: Current ability to tend safely to personal hygiene needs (specifically: washing face and hands, hair care, shaving or make up, teeth or denture care, or fingernail care). SOC/ROC D/C M Toileting Hygiene: Current ability to maintain perineal hygiene safely, adjust clothes and/or incontinence pads before and after using toilet, commode, bedpan, urinal. If managing ostomy, includes cleaning area around stoma, but not managing equipment. SOC/ROC D/C M Bathing: Current ability to wash entire body safely. Excludes grooming (washing face, washing hands, and shampooing hair). Includes shower in answers. M1900 removed. M has been changed. SOC/ROC, FU, D/C M Current Ability to Dress Upper Body safely (with or without dressing aids) including undergarments, pullovers, front-opening shirts and blouses, managing zippers, buttons, and snaps. SOC/ROC, FU, D/C M Current Ability to Dress Lower Body safely (with or without dressing aids) including undergarments, slacks, socks or nylons, shoes. SOC/ROC, FU, D/C No element for footwear. OASIS-D

20 OASIS-D GG0130 Self-Care Follow-Up

21 OASIS-D GG0130 Self-Care Discharge

22 OASIS-D GG0170 SOC/ROC with Discharge Goals Mobility Replaces GG0170C

23 OASIS-D GG0170 SOC/ROC OASIS-C2 OASIS-D Activities A, B and D are new for home health to assess. Activity B was assessed with GG0170C M Transferring: Current ability to move safely from bed to chair, or ability to turn and position self in bed if patient is bedfast. (Note - GG0170C is to and from the bed/chair or wheelchair) SOC/ROC, FU, D/C M Toilet Transferring: Current ability to get to and from the toilet or bedside commode safely and transfer on and off toilet/commode. SOC/ROC, FU, D/C Activities G through P, are new for home health to assess. Assessment questions R and S are a new. In the past clinicians were asked to report if a wheelchair was used. A scooter was not asked about and the type and proficiency of maneuvering one was not asked about.

24 OASIS-D GG0170 Follow-Up These are the same activities minus G, K, O, P, RR1, S and SS1.

25 OASIS-D GG0170 Discharge Skip pattern is different on for Q. If the clinician select No then they are asked to skip to J1800. GG0170 RR1 and SS1 are now RR3 and SS3, but the answer/content is the same.

26 OASIS-D J1800 and J1900 Health Conditions OASIS-C2 Data items collected at transfer or discharge from agency Since the SOC/ROC OASIS-D Data items collected at transfer, death at home or discharge from agency Since the SOC/ROC

27 OASIS-D M2310 Has Changed OASIS-C2 Transfer / Discharge OASIS-D Transfer / Discharge

28 OASIS-D M1033 OASIS-C2 SOC/ROC OASIS-D SOC/ROC

29 OASIS-C2 M2250 SOC/ROC and M2430 TRANSFER - RETIRED

30 Expansion of the Home Health One Clinician Convention Based on feedback from home health stakeholders, and to better align with assessment practices in other Post-Acute Care settings, we have modified the current home care guidance related to the one clinician convention. As required by the Conditions of Participation, the Comprehensive Assessment will continue to be the responsibility of one clinician. However, effective January 1, 2018, the assessing clinician will be allowed to elicit feedback from other agency staff, in order to complete any or all OASIS items integrated within the Comprehensive Assessment. Sources: CMS - Expansion of the Home Health One Clinician Convention Patient-Assessment-Instruments/HomeHealthQualityInits/HHQIOASISUserManual.html (scroll down page to see link for CMS OASIS Q&A August 2017 Expansion of the Home Health One Clinician Convention) To view the new OASIS, go to:

31 RESOURCES View the comparison of OASIS-C2 to OASIS-D at View the itemized list OASIS data elements at OASIS-D and other supporting analysis at Comment at Expansion of the Home Health One Clinician Convention Instruments/HomeHealthQualityInits/HHQIOASISUserManual.html (scroll down page to see link for CMS OASIS Q&A August 2017 Expansion of the Home Health One Clinician Convention)

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