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[CASE STUDY] Alleviating Clinician Workload by Outsourcing the OASIS Documentation

    Through Qavalo’s integrated clinical staffing solutions, Real Solutions Home Health Care in Delray Beach, Florida saw an upturn in their OASIS documentation and clinician experience at work.

    By outsourcing the charting of the OASIS, Real Solutions achieved significant improvements in the OASIS turnaround time while alleviating the weight of documentation duties for clinicians. Qavalo OASIS transcriptionists assumed the role of entering patient assessment data into the WellSky EMR using a specialized patient assessment form. This allowed clinicians to devote more of their time to patient care with less documentation load.

    Benefits Realized
    • Efficient patient assessment documentation
    • Faster OASIS turnaround
    • More accurate documentation
    • Improved clinician work satisfaction

    Clinician Charting Challenges

    Ensuring the completeness and accuracy of clinical documentation can be demanding. It is an equally important task that requires the same amount of time and effort as actual patient care. 

    Charting has been a major challenge for clinicians, especially in the home health setting where clinicians can spend extra hours after a long 12-hour shift to complete charts in the EMR. This has been found to cause burnout according to a study published in the Journal of the American Medical Association and Medical Care (JAMA) which discusses how the EMR system changes clinician work, productivity, and well-being.

    This hurdle compromises documentation quality, especially when key patient care information is overlooked, resulting in unsubstantial clinical narratives and inaccurate OASIS item interpretations, negatively impacting reimbursements and patient outcomes.

    This strenuous work nature has caused many clinicians to pursue other opportunities in other healthcare sectors. With the onset of COVID-19, healthcare demand has increased drastically, overwhelming the supply of clinicians and leaving the home health industry with major staffing challenges. Home health providers have struggled with employee retention, while recruitment has become the top challenge according to recent homecare staffing surveys.

    Streamlining Patient Assessment Documentation

    In an effort to boost clinician job satisfaction by reducing the charting workload, Qavalo has piloted an OASIS charting service for Real Solutions that primarily addresses patient assessment documentation and OASIS turnaround.

    Qavalo designed a Quick Assessment Form that standardizes the documentation done by clinicians during patient visits. The Quick Assessment Form is a template clinicians can use to capture and gather data from patient assessments. It only covers specific areas that are vital in creating the electronic OASIS chart, thus allowing clinicians to efficiently capture information during the actual patient encounter and make sure key details are not overlooked. 

    In comparison to WellSky’s OASIS form which consists of 239 items, Qavalo’s Quick Assessment Form only contains 89 items that clinicians are required to fill in, which translates into 65% less work. Using the information deduced from the Quick Assessment Form, Qavalo OASIS transcriptionists then complete the OASIS form in WellSky, including responding to the crucial functional M-items.

    Improving OASIS Turnaround Time

    There has been a 54% improvement in the OASIS turnaround time of Real Solutions since the electronic charting was outsourced to Qavalo in July 2021.

    Figure 1 shows the monthly average OASIS turnaround time from the patient visit to QA review completion

    In July 2021, the entire process took an average of 9 days to complete. When charting was outsourced, immediate improvements have been evident as the average turnaround time was reduced by 54%. By March 2022, the average turnaround time was reduced to only 4 days, which supports a faster completion of the Plan of Care (POC) and submission for Pre-Claim Review. With a shorter turnaround time of OASIS charts, the agency was able to promptly generate a POC, have it signed by the appropriate practitioner, and submit it to Medicare for Pre-Claim affirmation along with other documentation requirements.

    New workflows related to observing changes in the 2022 home health payment final rule were adopted in January. This required a considerable period of adjustment in the collaboration between clinicians and the outsourced team, which was promptly resolved by the following month.

    Concurrently, diagnosis coding has been initiated parallel to the electronic charting, considering all the necessary medical records references are available, hence ensuring the timely submission of the Notice of Admission (NOA) within the 5-day filing window. As soon as the electronic OASIS chart is complete and diagnosis codes are assigned, the OASIS chart is endorsed to a QA review team who returns the chart to the clinician for their signature or for further QA edits.

    Improving OASIS Quality

    Beyond improving the turnaround time, Qavalo’s OASIS charting service also contributed to increasing the quality of OASIS documentation.

    A) Better QA Return Rate

    Figure 2 shows the OASIS QA return rates under traditional charting and outsourced charting.

    By comparing the data, a significant improvement can be seen in the volume of charts being returned with QA points from the OASIS review.

    The percentage of charts that had QA issues is 64% under traditional charting and only 41% under outsourced charting. Even with the larger volume of OASIS charts completed through outsourced charting, the QA return rate was noticeably lower by 23%.

    Although QA points are significantly lower in number under outsourced charting, they can still be reflected in some charts. This is because Qavalo OASIS transcriptionists only enter data deduced from information noted by clinicians in the Quick Assessment Form. A separate QA reviewer team at Qavalo checks the chart for potential improvements and consistency with supporting clinical records.

    Similarly, figure 2.1 shows a quarterly comparison of the OASIS QA return rates from July 2021 to March 2022

    Under the traditional charting process, QA return rates were either relatively high or fluctuating. From 66% in Q3 2021, it increased to 67% in Q4 2021, then decreased to 50% by end of Q3 2022.

    On the other hand, a more consistent decline in the QA return rate can be observed when charting was outsourced to Qavalo. From 50% in Q3 2021, it continuously dropped to only 33% by Q1 2022, indicating a 17% progress.

    B) Better M-item Responses

    As a key area in the OASIS that impacts reimbursement values, the accuracy of responses to the 8 functional M-items is crucial.

    Figure 3 above shows the quarterly average number of QA points flagged around the 8 functional M-items in OASIS charts created by Qavalo.

    By the third quarter of 2021 —at the initial phase of the outsourced charting service— the average number of QA points was 38. Subsequently, by the 1st quarter of 2022, this number already dropped significantly by 75% to only 9 QA points.

    Boosting Clinician Engagement

    Clinicians at Real Solutions expressed their satisfaction that their workload was reduced without impacting their compensation, which can be considered positive feedback to encourage clinician retention. This is an indicator of the success of the outsourcing strategy in addressing the prevalent staffing shortage in home health. With Qavalo covering documentation, charting, and other administrative functions, Real Solutions’ in-house clinicians are able to focus on patient care.

    “We were looking for a way to help our clinicians not only improve their charting and speed of submission of the OASIS but also for a way to attract new nurses and therapists and retain the ones we have. We wanted our clinicians to be able to spend less time on documentation and more time caring for their patients and for them to understand that we value their time and that this trade-off meant less time on OASIS charting, which, in turn, increased their pay per visit when you decrease the time spent on documentation.

    Our nurses and therapists are very pleased with the EMR charting process of Qavalo. Once the OASIS is filled in by Qavalo, it’s returned to the clinician for review and approval. They aren’t just signing a document that they didn’t review for accuracy. Our nurses say they used to spend one to two hours at home charting on the OASIS, and now it takes about 20 minutes either at home or during the home visit to fill in the paperwork and attach it in Wellsky.”

    — Angi Lupton, Director of Nursing and Clinical Services

    Getting Support Where Needed

    With the current staffing challenge faced by the home health industry, innovative approaches are required. Increasing wages might not be sufficient without addressing the actual challenges that clinicians experience in their work. Having a reliable partner that can provide integrated clinical staffing solutions and back-office support can truly make a difference. By leveraging strategic partnerships, agencies can delegate other functions and direct their efforts to what matters most.

    Connect with us to learn more about the OASIS charting service or how you can build your own offshore back-office support team with Qavalo.