CMS’ future plans with OASIS-E involve cognitive assessments that could take your clinicians longer to complete at the time of assessment. It will add 27 new items — or standardized patient assessment data elements (SPADEs) — at various timepoints, as outlined in the 2020 PPS final rule and corresponding supplemental document.
The new items capture information on cognitive function and mental status; special services, treatments and interventions; medical condition and comorbidities; impairments; and social determinants of health.
More details and testing mean lengthier assessments
The items in Section C (Cognitive patterns) will take the most time to complete. They include the Brief Interview of Mental Status (BIMS) and Signs and Symptoms of Delirium from CAM, which require more details and lengthier testing.
Initially, the new OASIS item O0110 (Special treatments, procedures and programs), which asks about special treatments, procedures and programs, also will take longer as your clinicians learn what equipment is where on the form.
Cognitive question scores drive care
If the interview is deemed appropriate, as part of BIMS your clinicians will need to complete C0200 (repetition of three words). The first question asks the patient to repeat and remember three words. Then, after asking orientation questions, the patient is asked to repeat the three words from C0200. At the conclusion of the cognitive screening, scores are tallied up and entered in a box. If unable to complete the interview, the score is recorded as a “99.”
The cognitive questions also have a summary score. Your agency will need to develop a policy around what next steps are for patient care based on the scoring. If patients score a certain number then they get a referral to social work or to psychiatric care or determination that the physician needs to be notified.
Plan to set aside time and funds for training, but not yet
While it’s still too early to start training on this new document, it’s good to be aware of the changes coming down the pike. The time it will take to train staff on this is comparable to the time it took to train them on OASIS-D. CMS has not yet released the OASIS-E draft guidance, but when it does this will serve as a valuable tool for training staff.
Your agency needs to budget education dollars since there are many changes in OASIS-E including the need to educate about the cognitive question.
More OASIS changes on the way
- Transportation question. The new OASIS will assess a patient’s lack of transportation with clarification of what impact it has had, and an expanded medication reconciliation section with five questions. (Availability of transportation impacts discharge planning for the patient and patients’ ability to go to doctor appointments, outpatient therapy or the lab.)
- Mediation questions. Clinicians will need to complete Section N for medications. This queries about high-risk drug classification and use, capturing use of antipsychotic medication, anticoagulants, antibiotics, opioids, antiplatelets and hypoglycemic meds (including insulin).
OASIS-E publication resources
CMS published OASIS-E, which is scheduled to take effect Jan. 1, 2021, on its website March 18. View the draft of OASIS-E online here: https://www.cms.gov/files/document/draft-oasis-e-all-items03122020.pdf.
Find change tables and additional information released with the final rule in the downloads section at the bottom of the page, here: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Home-Health-Quality-Measures.