one black male nurse and one black female nurse looking at a computer screen
Adjust your agency's assessment attitude
by Valarie Johnson & Cindy Campbell

Amid historic industry growth and workforce shortages, we’re inching closer to the implementation of the new version of the Outcome and Assessment Information Set (OASIS). OASIS-E and Home Health Value-Based Purchasing (HHVBP) will go into effect on Jan. 1, 2023. While the draft of the OASIS-E guidance manual was released May 16 by the Centers for Medicare & Medicaid Services, it still must go through the full analysis and approval process.

Although we could begin training on new elements of OASIS-E, one of the best ways to prepare for the transition is to first ensure that your agency has mastered the transitional aspects of OASIS-D1. This will not only help with the implementation of OASIS-E in your agency, but can also help improve agency outcomes and boost clinician insight, engagement, and satisfaction. Remember that training too early on OASIS-E-specific items may be counterintuitive, as clinicians won’t be putting them into practice for months.

Accuracy & Timeliness Are More Important Than Ever

Accurate, comprehensive assessment and OASIS data are essential in demonstrating value-based performance in health care. If assessments are not completed on time, or if data is inaccurate, a series of cascading inefficiencies and errors may occur. The results can be devastating, including ineffective care planning, incorrect billing, the loss of hard-earned revenue and potentially more serious patient care errors.

The transition from OASIS-D1 to OASIS-E is the next step for the home health industry to better unify with other post-acute providers’ data collection and care delivery, with the goal of improving outcomes for Medicare beneficiaries.

The shift to OASIS-E supports initiatives set forth by the 2014 Improving Medicare Post-Acute Care Transformation Act. The implementation of the standardized patient assessment data elements (SPADEs) is supported by the addition of six new categories in OASIS-E. OASIS-D1 had previously added two SPADEs elements—GG: Functional Status and J: Incidence of Falls. The OASIS-E data set has a different look and flow, but a significant number of the OASIS-D1 data elements remain. We already know a lot about OASIS-E because so many of the items are already being collected in OASIS-D1.

The Best Initial Preparation for OASIS-E Is Mastering OASIS-D1

The transition from OASIS-D1 to OASIS-E is an opportunity for agencies to redesign their training programs into more continuous, focused educational processes that will create a culture of OASIS competence and confidence. Because clinicians come to home health with varied types and levels of professional experience, your agency’s training process is an opportunity to instill consistency of understanding and compliance across this diverse team of professionals. Most importantly, as you consider education for your agency, don’t focus only on the OASIS as a form that needs to be filled out. Instead, encourage deeper understanding of the underlying data elements and how each relates to the important business of patient care.

Here’s how you can optimize your approach to OASIS excellence.

1. Ensure competence in OASIS-D1.

This will position you for success under the current rulemaking and with the new OASIS-E guidance when it is finalized. You’ll then be ready to layer in these new elements throughout the second half of the year.

2. Start preparation at a foundation level for OASIS-E now.

This allows time for a more tailored learning experience to improve stakeholder retention.

  • Begin with an assessment of your agency’s health, including your operational efficiency.
  • Ensure that your agency’s coding and OASIS review partners and processes are data-driven and focused on building performance insight.
  • Establish electronic health record  documentation best practices and integrate analytics to help with clinical decision-making.
  • Perform OASIS baseline testing so you find gaps in knowledge.
  • Perform objective OASIS competence measurements in the field. Be sure your preceptors teach the same information.
  • Provide staff with digestible amounts of training content to help the learner stack skills and improve competence over time.
  • Get the timing right; build OASIS-D1 competence now by layering in OASIS-E-specific data guidance throughout the second half of 2022.
  • Encourage your leaders to familiarize themselves with the transitional relationship of the data elements between OASIS-D1 and OASIS-E. Note how the rearrangement of sections and addition of data elements might affect assessment techniques and consider training on the Confusion Assessment Method and Brief Interview for Mental Status assessment.
  • Fold in initial education on the new OASIS-E-specific data elements as indicated by your agency’s progress (but not too early, as clinicians will need to retain the new information in 2023).

3. Refresh your educational approach to building OASIS competence.

This can directly improve employee engagement and retention and change the narrative of OASIS importance—aligning it with patient advocacy and improvement of patient care.

The Benefits of Redesigning Your OASIS Approach

By improving the positioning and process surrounding OASIS, you may also improve efficiency, as less time will be spent fixing it. Generally, revenue follows accuracy; consider how front-line ownership of correct application of the data set at the point of service could free up time for improvements in your business and programs.

As health care moves deeper into a value-driven framework and the post-acute space transforms into a unified system, your actions today are critical to the success you may have in the competitive market moving forward. Adjusting your perspective on OASIS training and excellence is a great first step to a more positive performance trajectory in 2023.

Valarie Johnson, PTMS, COQS, CHHCM, HCS-D, HCS-O, is the senior clinical educator at WellSky.

Cindy Campbell, MHA, BSN, RN, is the director of operational consulting at WellSky.