O utcome And AS sessment I nformation S et

1. Outcome And ASsessmentInformation Set Gina Croft,MPT April 27, 2009

2. Objectives • At the conclusion of the training, the clinical staff will be able to: • Identify the comprehensive assessment requirements (patients, time points, procedures.) • Discuss the meaning of each OASIS item • Discuss the conventions (rules) to observe in completing OASIS items

3. Describe the assessment strategies to utilize for collecting OASIS data • Accurately conduct and document a start of care assessment • Accurately conduct and document a follow-up/discharge assessment

4. OASIS • Created by CMS to be the formal measure in home health to determine if pts in this setting were getting better • Never meant to be the payment tool • Money M0 questions • Tool for collecting data at start of care • Using that data to provide the foundation for how we plan care

5. Are we using this tool as a team? • Everyone has a stake as to whether or not the patient gets better • not just the admitting persons’ job • success/failure to achieve positive outcomes is a team effort!

6. Admission is a record of patient’s story • This visit gets a lot of attention because it drives reimbursement (not just about the admission!) • Admission compared to end of episode but also what are we doing in the middle; are we thinking about OASIS scores during our treatments?

7. What is improvement? • Are they any better from beginning to end? • Goal is not to fix pts • Ie: Moving from 3 to 2 shows improvement even though they still need help, they may not need as much

8. Chapter 8 instructions • Understand how to pick answers • Need to stay current; always changing • Most current guidance from CMS

9. Start of Care • Patient Tracking Sheet: • Items M0010, 0012, 0014, 0016, 0020, 0030, 0032, 0040, 0050, 0060, 0063, 0064, 0065, 0066, 0069, 0072, 0140, 0150: self explanatory or agency will supply proper id numbers. • Clinical Record Items • M080: who is filling out OASIS • M090: date it is being completed • M0100: mark only one response

10. Episode Timing: Early or Late? • M0110 • Identifies the placement of the current MCR payment episode in the patient’s current sequence of adjacent MCR payment episodes. • “Early” means the only episode OR the first or second episode in a sequence of adjacent episodes • “Later” means the third or later episode in a sequence of adjacent episodes.

11. Why Early vs Late • Had to do with cost info • Expenses are higher in later episodes • Higher expenses = more money • Autocorrect feature: • if marked early when it was really a late episode it will be corrected automatically • Some agencies were holding therapy until episode 3 or later (yes there are unethical folks in homecare!)

12. What does this mean for the rest of us? If we are providing therapy in a later episode, we need to be clear that is medically necessary

13. M0175 Discharged from where? • Identifies whether the pt has been dc’d from an inpatient facility within the last 14 days

14. Response-Specific Instructions • Mark all that apply. May have come out of the hospital and rehab facility within the past 14 days • Rehab facility defined as a freestanding rehab hospital or a rehab bed in a rehab distinct part unit of a general acute care hospital • SNF is a MCR certified nursing facility where the patient received a skilled level of care under the MCR Part A benefit

15. SNF • Determine the following: • Was patient dc’d from MCR certified SNF? If so then • While in the SNF was patient receiving skilled care under MCR Part A? if so then • Was the patient receiving skilled care under the MCR Part A benefit up to 14 days prior to admission to home health care? • If all 3 criteria then select response #3

16. M0180 Discharge Date • Identifies the most recent discharge from an inpatient facility (within 14 days) [14 days encompasses the 2 week period immediately preceding the start/resumption of care] • Use the most recent date of discharge from any inpatient facility

17. M0190: Inpatient Diagnosis • Identifies diagnosis(es) for which patient was receiving treatment in an inpatient facility within the past 14 days

18. Response-Specific Instructions • Include only those diagnoses that required treatment during inpatient stay • If a diagnosis was not treated during an inpatient admission, don’t list it (ie: pt has long standing history of OA but was hospitalized for peptic ulcer disease) • This is the diagnosis for which the patient received treatment • No surgical codes: list the underlying diagnosis that was surgically treated.

19. Coding • Fundamental pieces of coding • we own the coding process because it is what describes the patient • Primary diagnosis selected looks at patient in their entirety inclusive of any other services going out to the home and the main reason we are there

20. M0200: Medical or Treatment Regimen change within past 14 days • Identifies if any change has occurred to the patient’s treatment regimen, health care services, or meds due to a new diagnosis or exacerbation of an existing diagnosis within past 14 days

21. M0210: Medical Diagnoses • Identifies the diagnosis(es) that have caused an addition or change to the patient’s treatment regimen, health care services received, or meds within the past 14 days • Can be a new diagnosis or an exacerbation to an existing condition

22. M0220 • Identifies existence of condition(s) prior to medical regimen change or inpatient stay within past 14 days. • Past health history • Interview patient/caregiver. May call MD to get add’l info. • Determine any conditions existing before the inpatient facility stay or before the change in medical/treatment regimen • At DC omit NA and UK

23. M0230/240/246 • Identifies each diagnosis for which patient is receiving home care and its ICD-9-CM code • Each diagnoses categorized according to its severity • Primary diagnosis (M0230) should be the main condition/reason for providing home care

24. Secondary diagnoses in M0240 are defined as “all conditions that coexisted at the time plan of care was established, or which developed subsequently, or affect the treatment of care” • In general, M0240 should include not only conditions actively addressed in the patient’s plan of care but also any co-morbidity affecting the patient’s responsiveness to treatment and rehab prognosis, even if the condition is not the focus of any home health treatment itself. Avoid listing diagnoses that are of mere historical interest and without impact on patient progress or outcome

25. Case mix diagnosis • Diagnosis that gives a patient a score for Medicare Home Health PPS case-mix group assignment • May be the primary diagnosis, “other” diagnosis, or a manifestation associated with a primary or other diagnosis

26. Assessment Strategies • M0230/0240 Primary and Other Diagnoses • Interview patient/caregiver to obtain past health history; additional info from MD • Review current meds and other treatment approaches • Determine if add’l diagnoses are suggested by current treatment regimen and verify this info with patient/cg/MD

27. Assessing severity includes review of presenting signs and symptoms, type and number of meds, frequency of treatment readjustments, and frequency of contact with health care provider • Inquire about the degree to which each condition limits daily activities • Assess patient to determine if symptoms are controlled by current treatments • Clarify which diagnoses/symptoms have been poorly controlled in the recent past

28. M0250: Therapies • Identifies whether patient is receiving any of the listed therapies at home, whether or not the home health agency is administering the therapy

29. Assessment Strategies • Determine from pt/cg interview, nutritional assessment, review of PMH and referral orders • Assessment of hydration status or nutritional status may result in an order for such therapy/ies

30. M0260 Overall Prognosis • Identifies the patient’s expected overall prognosis for recovery at the start of this home care episode

31. Assessment Strategies • Interview for PMH and observe current health status • Consider diagnosis and referring physician’s expectations for this patient • Based on this info make informed judgment regarding overall prognosis

32. M0270: Rehab Prognosis • Identifies the patient’s expected prognosis for functional status improvement at the start of this episode of home care

33. Assessment Strategies • Interview for PMH and observe the current functional status • Consider diagnosis and referring physician’s expectations for this patient • Based on info received, make informed judgment regarding rehab prognosis

34. M0280: Life Expectancy • Identifies those patients for whom life expectancy is fewer than 6 months • Note: A DNR does not need to be in place

35. Assessment Strategies • Interview the pt/cg to obtain PMH • Observe current health status • Consider medical diagnosis and referring physician’s expectations for patient • If the patient is frail and highly dependent on others, ask the family whether the physician has informed them about life expectancy • Based on info received make an informed judgment regarding life expectancy

36. M0290: High Risk Factors • Identifies specific factors that may exert a high impact on the patient’s health status and ability to recover from this illness

37. Response Specific Instructions • Utilize agency assessment guidelines and informed professional decision making. • Consider amount and length of exposure when responding (Ie: smoking 1 cig/month may not be considered a high risk factor) • Specific definitions for each of these factors do not exist

38. Assessment Strategies • Interview pt/cg for PMH • Observe environment and current health status

39. M0300: Current Residence • Identifies where the patient is residing during the current home care episode • Observe the environment in which the visit is being conducted. • Interview the pt/cg re: others living in the residence, their relationship to the patient and any services being provided

40. M0340: Lives with… • Identifies who the patient is living with at this time, even if temporary • Need to know in order to plan care and services • Try to incorporate this question into the conversation, so the patient does not feel an investigation is being conducted

41. Includes: • one family member or other designated caregiver staying 24 hours/day with the patient even arrangement is temporary • Excludes: • Part time or intermittent caregiver • Several family members or caregivers who make up 24 hour shift

42. M0350: Assisting Persons… • Identifies the individuals who provide assistance to the patient (no home health) • “does anyone help you for any reason (personal care, household chores, errands, home maintenance, etc?) Who? • Paid help includes: • Services purchased in board and care or ALFs • Agencies other than home care agency

43. Paid help cont: • Other private or community services paid by patient, family, special program or community funds • Meals on wheels

44. Assessment Strategies • If patient mentions a friend or relative helping or coming to visit, interview to find out more about who helps patient, how often, what helpers do, etc. (applies to M0360, M0370, M0380) • In obtaining PMH, interview to determine whether ADL/IADL assistance is needed. • If so, request info on whether patient received assistance and from whom

45. M0360: Primary caregiver • Identifies the person who is “in charge” of providing and coordinating the patient’s care. • case manager hired to oversee care, but who does not provide any assistance is not considered the primary caregiver • This person may employ others to provide direct assistance, in which case, paid help is considered the primary caregiver

46. Assessment Strategies • From M0350, it is known that the patient receives assistance. • Interview to determine whom the patient considers to be the primary caregiver • For example, “of the people who help you, is there one person who is ‘in charge’ of making sure things get done?” “Who would you call if you needed help or assistance?”

47. Select “0-No one person” if: • The primary caregiver is the patient himself • There are multiple caregivers and each provides varying amounts of assistance and no one of them is “in charge”

48. M0370: How often… • Identifies the frequency of the help provided by the primary caregiver

49. Assessment Strategies • Ask, in various, ways, how often the primary caregiver provides various types of assistance • Ie: “how often does your daughter come by? Does she go shopping for your every week? When she is here, does she do the laundry? • As you proceed through the assessment (ADLs, IADLS) several opportunities arise to learn details of the help the patient receives

50. M0380: Type of Assist • Identifies categories of assistance provided by the primary caregiver (from M0360) • Not the type of help patient receives from all people who help