OASIS-C2 becomes effective for (M0090) Date Assessment Completed dates on or after January 1, 2017. I am here to tell you about the upcoming changes which, at a higher level, aim to more closely align the Home Health OASIS data set to other post-acute care standardized assessment data sets.
So what’s new?
There are actually only three new OASIS questions in the updated data set. The first new item is M1028 which asks whether the patient has an active diagnosis of Peripheral Vascular Disease (PVD), Peripheral Arterial Disease (PAD) or Diabetes Mellitus. The reason behind the addition of this question is because of the impact these diagnoses can have on all aspects of the patient’s life and healthcare. This question is only addressed on start of care or resumption of care. PVD or PAD is selected if the patient has a current ICD-10 diagnosis that starts with I70.2, I70.3, I70.4, I70.5, I70.6, I70.7, I70.91, I70.92, or I73. Diabetes Mellitus is selected if the patient has a current diagnosis that starts with E08., E09., E10., E11., or E13.
The next new item is M1060 which asks for the height and weight of the patient. The intent behind the addition of this item is to be able to calculate the home health patient’s body mass index (BMI) which can be used to assess the patient’s nutrition status. CMS also states that this information will be useful for wound healing and assessment of heart failure. The height is to be reported in inches and the weight in pounds, using whole numbers. If the measurement happens to be fractional, it should be rounded down for numbers under 0.5 and up for numbers equal to 0.5 and higher. Measurements should be taken consistently according to the agency’s policies and procedures. M1060 is only required at start of care or resumption of care.
The final new item is GG0170C which assesses the patient’s mobility limitations and the anticipated goal at discharge. This question was added to get the care team thinking about patient mobility to help decrease the risk of developing pressure ulcers. In a nutshell, at start of care or resumption of care, the clinician is to assess the patient’s current ability to get from lying on their back in bed to sitting on the side of the bed with their feet on the floor and no back support. Clinicians must assess the patient’s ability as well as the amount of and type of assistance provided by the caregiver (if there is a caregiver to assist). Then the clinician, with input from the patient and family, estimates the discharge goal and documents it.
It appears like a lot has changed if you look at the actual forms side by side, however, most of the changes are solely formatting revisions. Dashed lines have been replaced with boxes in many places. In the questions where there is only one appropriate response, there is now a box to enter the code of the response instead of marking the checkbox next to the answer. Also, roman numerals in the pressure ulcer questions have been replaced with arabic numerals so a “stage III pressure ulcer” is now a “stage 3 pressure ulcer”.
In places where the prior OASIS referenced “since the previous OASIS assessment”, the OASIS C-2 says “since the most recent SOC/ROC assessment”. Once and for all clarifying the intent of this question and eliminating recertification assessments from consideration when answering the question.
Some wound care questions were reworked. M1308 became M1311 and M1309 became M1313. M1311 did not change significantly for start of care or resumption of care assessments. For follow up (recertification) and discharge assessments, a second component has been added that asks how many of the stated pressure ulcers were present at the most recent SOC/ROC. M1313 added fields for entering how many unstageable pressure ulcers due to non-removable dressing and unstageable pressure ulcers due to suspected deep tissue injuries in evolution are present at discharge that were not present or were at a lesser stage at the prior SOC/ROC assessment.
A few medication questions were reworded as well. M2000 was updated to M2001. In that process, the instructions were simplified to eliminate the examples of clinically significant medication issues and the “Not assessed/reviewed” response was removed. M2002 was updated to M2003 with the instructions clarified for physician contact to be “by midnight of the next calendar day” and to “complete prescribed/recommended actions in response to the identified potential clinically significant medication issues”. Finally, M2004 was updated to M2005 to include the “midnight of the next calendar day” to contact and complete the “prescribed/recommended actions”.
Is that it?
Yep, that’s it. For now. As always, it’s important to keep on top of what each of these questions are really asking. If you’re not sure, you should always ask. Talk to the clinical management staff at the home health agency you work with. You can also find a lot of helpful information in the OASIS Guidance Manual. Go to Chapter 3 for an item-by-item listing of detailed instructions including the intent of each question, response-specific instructions, and data sources and resources that can be used in answering.
Will therapyBOSS be ready for OASIS C-2?
Glad you asked! The short answer is – of course. A release scheduled for December 23, 2016 will contain the new OASIS data sets. They will be selected automatically for documentation dates January 1, 2017 and after. Please note that we are not implementing the purely-formatting changes. These are superficial, as described above, and do not have any significance in the context of electronic home health documentation.