As a health care leader, I know you regularly find yourself navigating treacherous terrain: regulatory updates.
Some impacts are an easy stroll, like a small change in a quality metric, while others are a significant undertaking that impacts the whole organization, like a change in payment structure. The January 1, 2023, OASIS-E upgrade is one of those regulatory updates that will significantly impact home health agencies. It’s a mountain, not a hill!
Where to begin?
Ensuring success in integrating OASIS-E requires beginning with the end in mind. That means knowing your organization’s plan for climbing the mountain—before you begin, you should be able to answer a few key questions:
What is your organization’s mission?
What do you want for the patients you serve?
What are CMS’s goals?
Do they align with yours?
Would you be surprised to learn that the data you collect via OASIS is used to improve overall patient care by incentivizing best practices and enabling payment based on best outcomes rather than volume of services?
Does it help to know that the data also helps level the playing field, ensuring your agency is evaluated based on the challenges within your patient population and the resources available within your community?
What impact do you hope this new process will bring to your organization?
What mountaintop are you aiming for?
Beginning with the end in mind will inform how you respond as a leader.
You define the end; the mountaintop you want for your organization. You also choose the path to success for your organization. Choose a path that best matches your skills and comfort level and apply this same advice to choosing paths to educate yourself and your staff. Know your resources and use them. No one gets to the summit without the support of experts.
The first step on the journey to the top of the mountain is understanding the basics of the new OASIS-E. What is new? What has changed? What has gone away?
What approach works best for you? For your organization?
Will you explore the materials provided by the Centers for Medicare and Medicaid Services (CMS)?
Will you rely on an internal resource who is responsible for monitoring regulatory updates and coordinating your organization’s response?
Are you more comfortable relying on external resources to synthesize the information for you?
Familiarize yourself with OASIS-E, then work with your leadership team to integrate the changes into your organization’s mission and purpose.
Identify what matters to your patients, your referral sources, your staff, and your organization.
Use that information to spell out what success will look like; the mountaintop you have in mind for your organization.
Once you have identified what success looks like, you’ll be able to plan your path to the summit by building your response to the new OASIS-E regulations in a way that supports that success!
Why the change? I like my current path; it’s tried and true!
Let’s review what we know about the OASIS-E changes and why CMS is making them (rest assured, it’s not just for the fun of it).
Why did CMS make this change?
- Remember that CMS uses OASIS data to increase the use of best practices, improve patient outcomes, and control spending.
- CMS also made changes to ensure the OASIS-E tool was easier and more intuitive for the clinicians completing it. Some redundancies were removed as well.
CMS continues to update the OASIS data collection in order to better standardize data collection across all post-acute providers.
- This allows them to compare outcomes for patients receiving care in a rehab facility with outcomes for the same type of patient receiving care at home with home health.
CMS also adds new data collection items when research or experience identify new factors that positively or negatively impact health care outcomes.
- OASIS-E has several new items based on research and experience.
Examples from the new OASIS-E assessment include
- Asking patients about the language they prefer for receiving health care communication.
- Asking how often transportation is an issue when they need to get medications, supplies, or see their provider for a follow up.
- Asking home health agencies to document how often they supply an updated and reconciled medication list to the patient and subsequent provider upon transfer of care, a key safety measure shown to decrease patient harm.
OASIS data is used to capture information related to the quality of outcomes not only between settings, but between providers in the same setting type. Home Health agency outcomes, the degree of improvement compared to services rendered, is one such metric.
Do patients cared for by your agency demonstrate improved functionality upon discharge?
How does your performance compare to other providers in your area or providers with similar patient demographics?
Are your patients less likely to utilize emergency room and hospital services than those cared for by another provider or in another post-acute setting?
Are they more likely to have a medication related adverse event than is typically seen with other home health providers?
How does this change help me?
OASIS-E continues to require significant time and effort to complete. Understanding how the changes help you and your organization increases the likelihood of success, whether you are navigating changing regulations or an icy mountain trail.
OASIS-E’s improved data collection is both specific and tailored to the post-acute health care patient population. It captures both patient and outcome data that was previously not available for inclusion in calculating quality scores. We know most patients would prefer to receive care in their home. Showing your organization achieves better outcomes at a comparable or lower cost means patients can continue to have the option to receive care in their home in the future.
OASIS-E items are designed to capture data related to patient characteristics and agency practices that impact outcomes. We know each organization cares for a unique patient population with a unique set of support systems available. My rural town has a small pharmacy which is open 9-5 Monday through Friday and half a day on Saturday. The nearest pharmacy with extended hours is a 30-minute drive. That surely makes a difference in outcomes for patients who need a medication adjustment to manage new or worsening symptoms.
Think about the challenges your patients face and how collecting more data might help you capture those challenges:
Can you see how some of the new OASIS data items might help improve your scores?
- Assessing for and identifying patients at risk for depression allows your agency to be proactive in addressing any needs before they become a barrier to therapy or other care, thereby improving outcomes.
Will some of this data level the playing field, ensuring your data is compared to other home health agencies with similar demographics?
- Perhaps your agency has a higher level of emergent care use. Understanding that the patient population you serve has a high incidence of transportation barriers impacting their ability to get their medications and supplies and keep their follow-up appointments allows you to target those challenges. It also means your outcomes can be compared to home health agencies with similar transportation barriers.
Can the data be used in your quality improvement program?
- Maybe your data related to providing the current reconciled medication list to the next provider identifies a gap.
- How impactful might it be if you tightened up that process?
- Smoother transfers?
- Fewer hospitalizations or emergent care use related to a transition that did not meet best practice standards?
Let’s review what we do know about the timing and training for the OASIS-E update.
Home Health updates occur on a calendar year format, meaning home health agencies find themselves needing to provide some significant training at the end of the year when employees are at their busiest completing their annual trainings, and balancing holiday commitments with an influx of patients related to end-of year procedures requiring home health support.
CMS final updates are usually available sometime in August, which leaves little time for the development and delivery of training related to updates.
A support partner is critical to your success!
It matters who’s leading the way!
Your organization’s success depends on your leadership. Leaders who are knowledgeable about the changes and emphasize the positives with their staff get better buy-in, which smooths the path up the mountain. Leaders who bemoan the changes and minimally support the training necessary to comply with the regulatory updates will find their path a bit bumpier.
How will you communicate the changes to your staff?
Will you focus on the disruption caused by the changes?
Will you highlight the benefits associated with the changes and paint the time and training required as an investment for a process that improves the quality of care, data collection and health care spending?
Can you clearly articulate what the mountain top looks like and how important it is to work together to reach that mountain top?
Are you willing to invest in the training and supplies you need to reach the mountain top you defined for your organization?
Get help navigating to the summit
Now that you have identified what success looks like for your organization and communicated that vision to your staff, you are ready for training.
Like with most hikes, you don’t need to go it alone. For help reaching the mountain top:
Watch our webinar, Climbing the OASIS-E Mountain, which covers the why behind the changes, how to access available resources, samples from CMS, and a review of how the data is used.
Look for our suite of OASIS-E training courses, designed to meet the needs of both seasoned and new home health clinicians (OASIS D-1 to OASIS-E Updates, OASIS-E Basics, OASIS-E Section by Section).
Check out the links below for easy access to the CMS OASIS-E Guidance Manual, CMS OASIS updates page, and their quarterly updates.
We wish you the best on your journey to the mountain top. We’ll be there supporting you on your way to success!