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[UPDATED] Major Changes in the new OASIS-E: Restructured Sections, Additional Assessments

    With the release of the latest OASIS-E draft last February 1, now is good timing for home health agencies to already start training with the new changes. By January 1, 2023, the OASIS-E will be implemented in line with the nationwide expansion of the Home Health Value-Based Purchasing (HHVBP) Model.

    Many new changes will shift the entire structure of the OASIS. All current revisions are consistent with the Improving Medicare Post-Acute Care Transformation (IMPACT) Act to promote interoperability between care settings. By having identical data assessment items as other settings, interoperability will increase when each setting uses the same criteria to complete the data set.

    The data elements of OASIS-E will also aid in addressing the needs of individual patients with a focus on executing care delivery to patients holistically. Overall, there will be improvements in the safety and quality of care to patients.

    What’s New in OASIS-E

    Restructured Sections

    There are now sections in the data set representing letters A through Q wherein many new assessment items beginning with those letters can be found, as well as the current OASIS D1 items divided under these new sections. 

    Some of the current assessment items will remain with the character designation of “M” but many will be placed in the corresponding lettered section with similar items. For instance, Section M in OASIS-E represents the integumentary system, so only “M” items that pertain to wounds will be here. Other current “M” items will be placed in the letter section they correspond with. Another example is the M1720 “When Anxious,” which will be located in Section C together with other new cognitive items, such as the “Brief Interview Mental Screening” (BIMS) and the “Confusion Assessment Method” (CAM).

    New Assessments

    Here is a rundown of new facets to the OASIS-E, which includes additional assessment items:

    Social determinants of health (SDoH)

    Agencies will now be able to collect and identify these actionable items, which should ultimately lead to better patient outcomes. 

    Facilitation of the transfer of health information between post-acute providers

    The new OASIS-E will include a new Transfer of Health (TOH) information item. The timeliness of a reconciled medication list to a subsequent provider in the next care setting, or a patient when discharged, will now be measured. Soon, the transfer of health information will be added to the Home Health Quality Reporting Program. Research shows that poor patient outcomes are directly related to medication issues, which is why this development is so important for medication reconciliation and education to address this problem and push better patient outcomes.

    New assessment questions for high-risk medication teaching

    A new OASIS item N0415 specifically identifies the high-risk drug classes, such as antipsychotics, anticoagulants, antibiotics, opioids, antiplatelets, and hypoglycemic drugs, which CMS requires patient teachings for.

    Additional behavioral assessments
    1. Brief Interview for Mental Status (BIMS) – This will establish a cognitive baseline by testing recall and temporal orientation.
    2. Signs and Symptoms of Delirium – This helps to identify delirium, which is often reversible if identified early.
    3. Patient mood interview – This is an expanded depression screening, which will give further details on the severity of depression.
    Other notable changes
    1. Addition of “Patient declines to respond” as an option to the following items:
    • A1005 (Ethnicity)
    • A1010 (Race)
    • A1250 (Transportation)
    • B1300 (Health literacy)
    • D0700 (Social isolation)
    1. Expanded questions on pain and infusion

    Transition Challenges

    OASIS data collection directly impacts payment and outcomes. Data from home health reimbursements in relation to the OASIS functional items will also be used in the value-based purchasing program in 2023. Thus, it is important that the data accurately reflects the status of the patient.

    It will be a learning process leading up to the implementation of OASIS-E next year. The mental health assessment alone will take some education on the clinician’s part because it is not typically part of their tasks.

    With all these considered, clinicians must have a thorough understanding of OASIS and how it plays an impact at start, at resumption, and at discharge. 

    Prepare Now

    According to recent survey data, about 40% of agencies currently do not have a plan in place for OASIS-E. However, there is no better time to start preparing than now, so there is more room for learning and adjustment for clinicians.

    While the final version of OASIS-E is yet to be released later this year, agencies can take advantage of draft versions for early training of clinicians. It may take some time for clinicians to get everything right with all the new changes in the OASIS-E documentation. Your QA program will be of great help in maintaining documentation accuracy and optimizing reimbursements. Start talking about OASIS-E with your QA provider at the earliest opportunity to get on top of the new standards and guidelines.

    The updated OASIS-E draft can be downloaded here>