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Beyond GG and M1800: Crucial OASIS Items for Risk Adjustment

    It is undeniable that the M1800s and GG items are crucial components of the OASIS impacting quality outcome measures and reimbursements. However, agencies should not overlook the importance of other OASIS items, which provide essential data for risk adjustment beyond mere documentation compliance.

    Risk adjustment in home health is a methodology used to account for the varying health statuses and related care needs of patients when assessing performance outcomes and determining reimbursements. It involves adjusting quality measures and payment rates based on specific characteristics and severity of a patient’s condition. This ensures a fair comparison among home health agencies by considering factors such as age, comorbidities, and functional status, which might otherwise skew performance metrics and financial incentives.

    In essence, risk adjustment helps to:

    1. Ensure Fair Comparison: By accounting for differences in patient populations, it allows for a more accurate comparison of performance across different home health agencies.
    2. Quality Measurement: Improve the reliability of quality metrics by considering patient risk factors, leading to better identification of areas needing improvement and ensuring high-quality care delivery.
    3. Appropriate Reimbursement: Adjust payments to reflect the expected costs of caring for patients with varying levels of health and functional status, ensuring agencies are fairly compensated for the complexity of care they provide.

    This risk adjustment methodology utilizes responses from specific OASIS items to adjust payments, ensuring a fairer comparison of patient outcomes. By adjusting for individual patient characteristics, it enables an “apples-to-apples” comparison of outcomes across different patients.

    Understanding the intent and guidelines for OASIS items like M1100 – Patient Living Situation, M1710 – When Confused, M1720 – When Anxious, and M1610 – Urinary Incontinence or Urinary Catheter Presence can help agencies better capture patients’ needs and complexities of their conditions. This leads to more accurate and fair comparisons in publicly reported risk-adjusted outcome measures.

    The OASIS-based outcome measures for which the updated risk adjustment models apply:

    • Improvement in Ambulation/Locomotion
    • Improvement in Bathing
    • Improvement in Bed Transferring
    • Improvement in Bowel Incontinence
    • Improvement in Confusion Frequency
    • Improvement in Dyspnea
    • Improvement in Lower Body Dressing
    • Improvement in Upper Body Dressing
    • Improvement in Management of Oral Medications
    • Improvement in Toilet Transferring
    • Discharged to Community 
    • Discharge Function Score (available in 2024)

    Access the Risk Adjustment Technical Steps and Risk Factor Specifications for detailed information on how risk adjustment is calculated and which OASIS items are used and the risk adjustment methodology.

    Thorough and accurate documentation is equally crucial as the actual patient care in home health. Continuing education of clinicians on answering various OASIS items offers significant benefits to home health agencies on different levels from comp