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OASIS-E Challenges and Solutions: Section C and BIMS

    The new OASIS-E emphasizes assessing patients’ cognitive function. Section C provides detailed guidance for evaluating memory, communication skills, and decision-making. The manual also includes tools to identify delirium, such as the Brief Interview for Mental Status (BIMS), which assesses attention, recall, and orientation. This section can improve clinicians’ evaluation and care planning for patients with cognitive impairment.

    What Is BIMS?

    BIMS is a standardized tool that can provide valuable information to clinicians in evaluating patients for possible dementia diagnosis. While it cannot be used to make a diagnosis itself, BIMS can help determine whether a more in-depth evaluation by a physician is necessary. BIMS consists of five OASIS items that are used to evaluate the patient’s temporal orientation, ability to repeat words spoken by the clinician, and recall those words with or without cueing. BIMS scoring can also help identify social determinants of health risk factors and basic needs. The test is easily replicated, making the results more consistent with tests performed by other care providers.

    Challenges of Completing Section C and BIMS

    The cognitive function section of the OASIS-E poses challenges for clinicians in understanding the meaning behind the assessment items and using the information in other parts of the assessment to respond accurately. To improve scoring on this section, clinicians should consider other OASIS items that may affect the current cognitive state of a patient. Confusion and delirium, for instance, are frequently a symptom of a urinary tract infection. However, once the infection is cleared, the confusion resolves itself. Corrective action can lead to significantly better outcomes.

    Additionally, many clinicians find the BIMS one of the most confusing and complex parts of the OASIS-E. Some clinicians opt not to perform the interview, indicating that patients cannot understand and therefore cannot participate in the interview. However, It is essential to figure out, for instance, why a patient has difficulty with language or speech, examine what is going on with the patient, and try to accommodate them for BIMS interview. Failing to do so may cause a disconnect between what is being documented on the assessment and what is being documented on the medical record, which could lead to problems for agencies come survey time. The challenge with the OASIS item may be due to inadequate training for clinicians. Administering the BIMS can be time-consuming, especially if the patient has difficulty understanding or answering the questions, hence, clinicians need to be trained on how to streamline this process without compromising the quality of the assessments.

    Scoring Section C Items Accurately

    To ensure accurate and complete scoring, clinicians responding to items regarding a patient’s cognitive status should involve caregivers or family members whenever possible. Patients may not remember or disclose information accurately, making it important to have additional perspectives. This is particularly crucial for C0100, “Should Brief Interview for Mental Status be Conducted?” If a caregiver or family member is unavailable, clinicians should take the full five days allotted by the Centers for Medicare and Medicaid Services (CMS) to complete the assessment and gather the necessary information.

    Educating staff on the intent of the item and the potential impact of inaccurate responses on other assessment items is the most valuable strategy. However, the cognitive status section of the OASIS assessment is challenging, and clinicians must invest time and effort into learning how to use and score the screening tools required.

    Promoting Patient-centric Care Through BIMS

    BIMS is a simple cognitive screening tool that plays a critical role in detecting cognitive impairment in older adults, which is linked to the patient’s ability to self-manage their disease state and a higher rate of hospital readmission in Medicare patients. This underscores the importance of ensuring that patients with cognitive impairment have caregivers who can manage their disease state effectively.

    The first item in Section C of the OASIS assessment determines whether a structured cognitive interview should be conducted using the BIMS tool. Conducting the BIMS assessment can help clinicians gain insight into the patient’s cognitive status, which may not be evident through observation alone. This information is vital for creating a comprehensive and valid plan of care and ensuring quality outcomes. As such, clinicians must be trained to understand the importance of using the BIMS tool accurately and reliably.

    New OASIS-E Resources from CMS

    CMS has added cue cards as a supplementary resource for providers to assist in conducting the BIMS, Patient Health Questionnaire (PHQ-2 to 9), and Pain Interview as referenced in the OASIS-E coding guidance. The OASIS-E Manual provides detailed instructions on how to use the cue cards and administer the BIMS. These cue cards are intended to provide a visual reference for the coding of response options.

    The cue cards are available for download on the CMS Home Health Quality Reporting Training webpage.

    Additionally, CMS has released a 5-minute video tutorial to assist providers in coding GG0170C, Lying to Sitting on Side of Bed, using simulated patient scenarios.