Would watching the Jetson s have given you any prediction on the future for OASIS? Presented by: Fern Dewert, R.N., O.E.C., C.O.S.C, & Joyce Rackers, R.N., B.S.N, C.O.S.C Bureau of Home Care & Rehabilitative Standards Fern.Dewert@health.mo.gov Joyce.Rackers@health.mo.gov APRIL 2016 1 LET S SEE HOW IT MIGHT HAVE GONE.. Mr. Spacely: Jetson! Thank goodness you're still here! I've got some good news and some bad news... George Jetson: What's the bad news, Mr. Spacely? Mr. Spacely: We've discovered a new assessment for home care that you have to start soon! George Jetson: But we just had an OASIS change! By the way... what's the good news? Mr. Spacely: The good news is I m not the one that has to do it! Bye now! 1
Objectives The participant will be able to identify the major changes in the Draft OASIS C2 Item set scheduled for implementation Jan. 1, 2017. OASIS C2 Draft released Dec. 22, 2015. Scheduled for implementation Jan. 1, 2017. Created to comply with the requirements for standardized, cross setting measures for post acute care (LTC Hospitals, IP Rehab, SNFs and HH) under the Improving Medicare Post Acute Care Transformation (IMPACT) Act of 2014. The IMPACT ACT Requires reporting of standardized patient assessment data with regard to resource use and quality measures. Requires the data elements (and for HH, the OASIS) to be standardized to allow for the exchange of data among post acute care providers to facilitate coordinated care and to improve Medicare beneficiary outcomes. 2
The IMPACT ACT (cont.) Outlines the timelines in which each of the four (4) post acute settings must begin collecting the standardized data and reporting of the quality measures that are standardized across the four (4) settings. For home health the first impact measures will be collected & reported starting Jan. 2017. More about the IMPACT Act The first OASIS derived impact measures that will be required for HH include: A composite measure related to drug regimen review; that is to satisfy the medication reconciliation impact requirement. And the worsening in pressure ulcer status since the SOC or ROC; that will be used to satisfy the skin integrity impact domain. More IMPACT ACT. In addition, HH will have a couple of claims based measures related to resource uses Discharge to community measure, a hospital readmission measure, and a Medicare spending per beneficiary measure. 3
Looking even further in to the future 2019 Starting in 2019. Home Health will have several more OASIS based impact measures (Functional status goal setting for function & incidence of major falls) starting in 2019. AND.. The new items that will be needed to calculate those measures are not being added to OASIS C2 at this time but CMS is introducing a number of changes just to the data set in efforts to increase standardization between the OASIS & patient assessment instrument for the other three (3) institutional post acute settings (SNF, IP Rehab, LTC Hospitals). 4
Summary of the Major Changes in the Data Set For 2017 This version includes three (3) new standardized items: M1028, M1060, GG0170c Modification to and renumbering of select medication and integumentary items to standardize with other post acute settings of care: M1311, M1313, M2001, M2003, and M2005 The look back period and item number was changed in five (5) items: M1500, M1510, M2015, M2300 and M2400 Summary of Major Changes cont d Formatting changes were made throughout the document to convert multiple check boxes to a single box for data entry where responses are mutually exclusive, and to change the numbering for pressure ulcer staging from Roman to Arabic numerals. Let s hear more of George s reaction to Mr. Spacely s OASIS announcement. 5
Co Worker: Did you hear Mr. Spacely's (CMS) latest plan? George Jetson: Yeah, the slave driver. Imagine implementing another new OASIS that s going to mean at least a four day week. What does he think this is? The 20th century? Then George goes home to Jane, the love of his life and says.. Jetson: Jane. Stop this crazy thing! What are the actual proposed OASIS C2 Changes? There will be more boxes instead of spaces Steps toward standardizing the format of the OASIS assessment with the other post acute care (PAC) settings assessment tools. 6
Single Box Formatting The answer is entered in to a single box. Only one response is allowed, for example, M0069 (Gender). This is contrary to M0140, where you will see multiple boxes. This is a mark all that apply item. For any mark all that apply item, the multiple boxes remain. But for those items that require only one response, the single box formatting is displayed. Single Box Formatting (cont.) Makes some of the items look very different for example, M2102. The only change from C1 is the single box formatting. In C1, the text for the responses are housed in the header row at the top of the columns but is now repeated in every row. Makes the item look new & different even though the wording is unchanged. Exceptions to the Single Box Formatting Some items were not modified Tables for example, M2250 For this item, only 1 box is allowed for each row but because there is additional text for the NA responses and it is different row by row, single box format is not as easily introduced. 7
New Item: M1028 Active Diagnoses Comorbidities and Co existing Conditions Added to OASIS C2 to allow HHAs to collect in the same way providers do in the other post acute care settings. Are reporting whether or not your patient has an active diagnosis of PVD, PAD or DM. This item will allow for risk adjustment of the pressure ulcer measure (percent of patients with pressure ulcers that are new or worsened) if your patient has one of these 3 diagnoses. New Item: M1060 Height and Weight While measuring, if the number is X.1 X.4 round down; X.5 or greater round up Also added to OASIS C2 as a means of risk adjustment for the new or worsened pressure ulcer cross setting measure. Ht. and wt. reported by the agency will be used to calculate the patient s BMI. It is actually the patient s low BMI that will be used to represent the risk for the pressure ulcer quality measure. M1311 Current Number of Unhealed Pressure Ulcers at Each Stage This represents a modification of an existing M Item, in this case M1308. In each row you will report the number of pressure ulcers that are current at each stage at the time of the assessment. (How many stage II, stage III, etc.) Then at f/u and discharge, you will answer a second question on each row What is the number of these stage pressure ulcers that are current at this f/u or discharge that were also present at most recent SOC/ROC? 8
M1313 Worsening in Pressure Ulcer Status since SOC/ROC This represents another modification of an existing M Item, in this case M1309. This is only collected at discharge. This item is similar to M1311 with a couple notable revisions: Added non removable dressing Added Suspected Deep Tissue Injury A Cosmetic Change Whenever referencing pressure ulcer stages, the Roman numeral has now been changed to Arabic. This was changed throughout the pressure ulcer items and it now aligns with how pressure ulcer stages are addressed in the other post acute care setting s assessment tools. M1501 Symptoms in Heart Failure Patients This is the OASIS C2 version of M1500. The changes made relate to the time period of consideration. Currently M1500 reports if a patient has a diagnosis of heart failure & if they do have they exhibited any symptoms of heart failure at the time of or since any assessment. Now the item s look back period is at the time of or at any time since the most recent SOC/ROC assessment. 9
Other look back changes This change in look back will occur in four (4) more data items. M1511 (pg. 15) M2016 (pg. 21) M2301 (pg. 25) M2401 (pg. 26) The look back is now at the time of or at any time since the most recent SOC/ROC assessment. Section GG: FUNCTIONAL ABILITIES AND GOALS SOC/ROC Item GG0170C Mobility Code the patient s usual performance at the SOC/ROC using the 6 point scale. If activity was not attempted at SOC/ROC, code the reason. Code the patient s discharge goal using the 6 point scale. Do not use codes 07 (Patient refused), 09 (Not applicable) or 88 (Not attempted due to medical condition or safety concerns) to code discharge goal. Item GG0170C Mobility Reports the patient s status in only the functional task of going from lying to sitting on the side of the bed. Specifically the ability to safely move from lying on the back to sitting on the side of the bed with feet flat on the floor and with no back support. The item has CMS guidance right in the item. If helper assistance is required because patient s performance is unsafe or of poor quality, you are to score according to the amount of assistance provided. Activity may be completed with or without assistive devices. 10
Why the new GG0170C? This item will also be used to risk adjust the worsening in pressure ulcer quality measure. It will represent the general pressure ulcer risk of impaired or limited mobility. Things to know about GG0170C Has a unique set of response codes that is different than what is currently used in any other data item in the OASIS data set. The response scale is reverse of that used for the other functional items. The bigger the number on the GG item, the more independent the response. More things to know about GG0170C Also has some options that allow us to respond the patient refused, the task is not applicable or that the task was not attempted due to medical condition or safety concerns. In addition to reporting the patient s status at SOC/ROC, we also have the opportunity to report a discharge goal for the patient for this supine to sit mobility task. 11
Medication Item Changes M2001 Drug Regimen Review (Revision of M2000) M2003 Medication Follow up (Revision of M2002) M2005 Medication Intervention (Revision of M2004) Medication Item Changes cont d These three (3) items (M2001, M2003 and M2005) Will be used in combination to calculate a cross setting impact composite measure titled, Drug Regimen Review Conducted with Follow up for Identified Issues. The composite measure is going to report the percentage of home health episodes in which a drug regimen review was conducted at the SOC/ROC and timely follow up with the physician occurred each time potentially significant issues were identified throughout the episode of care. Another change for M2005 Medication Intervention Will now be required to be completed for RFA 8, Death at home. (For M2004 in the current OASIS C1/ICD 10 version, it is collected only at transfer and discharge.) For OASIS C2, the time points for collection of this item will be transfer, discharge and death at home. 12
Prior to implementation on 1/1/17, CMS will have all of the usual resources updated. But in the meantime, if you start reviewing the OASIS C2 and you have questions, feel free to contact either Fern Dewert or Joyce Rackers and we will forward your question on to CMS. Or.. You can email CMS directly at cmsoasisquestions@oasisanswers.com So how do you think the conversation would go now for George after he s heard all about OASIS C2? George Jetson: I've got a wife, two kids and 10 finance companies to support. How am I supposed to pay my bills and do OASIS C2? 13
Mr. Spacely: JETSON. YOU'RE FIRED! George enlists advice from Henry Orbit.. George Jetson: I'm a big coward. I m scared of that OASIS C2. Henry Orbit: Now, now, Mr. Coward. Er, I mean Mr. Jetson, there's nothing to worry about. Even Mars has OASIS C2. Why I got a third cousin who's making out real well on Mars. George Jetson: I don't think I could take Mars, Henry. I hear those little green bosses are murder. I will just do OASIS C2 right here and it will be just fine. 14