Q4 training should focus on OASIS E for key reimbursement impact

Home health agencies should prioritize fourth quarter training on understanding important OASIS changes that will pay off in 2023 and beyond, SimiTree consultants say.

A complex new version of home health’s Outcome and Assessment Information Set, the OASIS E, launches Jan. 1. It will be the most intensive remake of the OASIS in decades and will impact home health payments on multiple fronts.

In addition to determining ongoing reimbursement amounts under Medicare’s Patient-Driven Groupings Model (PDGM), OASIS E items will directly impact future payment adjustments under Value Based Purchasing.

“It’s important for agencies to understand the significant impact OASIS-E is going to have on their reimbursement,” said SimiTree Principal J’non Griffin, who serves as SVP for Coding and OASIS.

“While it has always had an impact on reimbursement, that is going to intensify next year under VBP. Every home health agency needs to prioritize OASIS E training during the fourth quarter to be fully prepared for its impact,” she said.

Increasing payment impact

The OASIS is a patient-specific assessment required by the Centers for Medicare and Medicaid Services (CMS) to plan care for patients and measure quality as well as determine reimbursement. Clinicians must complete the assessment at several timepoints throughout a patient’s episode of care. OASIS items measuring a patient’s functional abilities are factored into determining how much reimbursement Medicare will provide.

Beginning in 2023, some OASIS items will also impact an agency’s total performance score under VBP, and the score will determine whether agencies receive a payment increase or decrease in 2025.

Under the nationwide rollout of VBP in 2023, an agency’s total performance score will be determined by OASIS-based measures, claims-based measures, and certain scores from a 34-item HHCAHPS survey used to capture patient perspective of services received.

OASIS E changes

OASIS E has been restructured to increase cross functionality among post-acute care providers and meet requirements set out by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014.

The D-1 version released a few years ago enabled CMS to align the OASIS with similar data collection instruments used by other providers, such as the Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI), the Long-Term Care Hospital assessment set, and the Minimum Data Set (MDS) used by Skilled Nursing Facilities.

OASIS-E will continue the alignment of data collection by introducing many new assessment items in these primary categories:

• SPADEs: Standardized Patient Assessment Data Elements

• BIMs: Brief Interview for Mental Status

• SDHs: Social Determinants of Health

“These new assessments will capture information about the patient’s cognitive patterns, behavior and mood,” Griffin said.

In addition to adding new assessment items and changing the structure of the assessment, the new OASIS E changes some current guidance for scoring items, Griffin said.

“The changes are numerous, bringing a real learning curve for agencies, and are going to require some intensive preparation,” Griffin said.

OASIS-E data collection begins with assessments that have a M0090 date on or after Jan. 1, 2023.

Comprehensive OASIS E Training Sessions

SimiTree consultants offer OASIS accuracy training in both a comprehensive, virtual classroom format and in agency-specific, customized training sessions.

Use the form below to ask us about customized OASIS E training for your agency or sign up for the virtual classroom training which begins next week.

Registration is still open for a comprehensive series of three sessions of OASIS E training, three hours each.

· Session 1 – September 27, 28, & 29 (1:00 – 4:00 EST)

· Session 2 – November 9, 10, & 11 (1:00 – 4:00 EST)

· Session 3 – December 6, 7, & 8 (1:00 – 4:00 EST)

Appropriate for assessing clinicians, case managers, clinical managers, reviewer or administrator level attendees, the series will focus on all new and changed items, as well as selected OASIS items impacting home health quality scores and payment.

Attendees will be eligible for 9 hours of HCS-O CE credits and 9 Nursing CEUs. Registration information and details about the sessions may be found here.