Posted Monday, April 17, 2023
McKnights Home Care
By: Liza Berger
It’s too early to know the impact of the latest version of the Outcome and Assessment Information Set, better known as OASIS-E, which went into effect for Medicare-certified home health agencies on Jan. 1. However, one new standardized assessment item, the Brief Interview of Mental Status, under Cognitive Function, so far has emerged as the most problematic, according to Mary Carr, vice president for regulatory affairs for the National Association for Home Care & Hospice.
“This is the most confusing and complex item on the OASIS today and it’s a new item as well,” she said during a webinar Thursday sponsored by Relias, which specializes in training across the post-acute care sector.
Many clinicians are opting not to perform the interview, indicating that patients cannot understand and therefore cannot participate in the interview. But the Centers for Medicare & Medicaid Services in most cases begs to differ, she said.
“[Patients] can be confused and still participate in the interview,” Carr said.
If a patient has difficulty with language or speech, it’s important to figure out why. “You need to examine what exactly is going on with the patient and try to accommodate,” she said, adding, “You don’t automatically say no.”
This item could lead to problems for agencies come survey time, Carr explained. It’s often learned that the client is actually cognizant and alert.
“There’s a real disconnect between what is being documented on the assessment and what is being documented on the medical record,” she said.
One cause of the challenge with the OASIS item is training, Carr noted. Possibly due to the staff shortage, managers and reviewers are opting to undergo the training themselves, shielding the clinicians. They then are passing information on to clinicians.
“It’s not properly training the clinicians to begin with and hoping you can catch up later,” she said.
OASIS, a group of standard data elements home health agencies integrate into their comprehensive assessment, to collect and report quality data to CMS, is a response to the Impact Act. The latest version, “E,” is expected to be the last.
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