Hospitalization in the Five Day Window
In spite of careful planning on the part of nurses, therapists and physicians, it sometimes happens that a patient will go to the hospital after a recertification OASIS was completed and actually stay in the hospital for the duration of the episode and into the following episode. When this happens, it is frequently the case that the patient must be discharged and readmitted, but not always.
If a patient comes out of the hospital after the episode has ended and if (and only if) the patient has the exact same HHRG as the prior episode, only a resumption of care assessment is required. To determine if the HHRG is exactly the same, you may use the CMS toy grouper or PPSGrouper.com. Alternately, your software may have the capability or you can painstakingly compare answers with the last assessment while remembering that differing answers do not always result in differing HHRGs.
If the HHRG does differ then the patient must be discharged and readmitted to the agency. In order to accomplish this, most agencies begin a new chart. This is also problematic because often times, the second chart appears to be incomplete. For instance, you may have a situation with unstable caregivers that has previously been addressed by your social workers. In the new chart, all a reviewer may see is the unstable caregiver situation without reference to any intervention. Therefore, our suggestion is that when you must readmit a patient due to intervening hospitalizations to always reference that this is a readmission due to OASIS considerations. This allows your quality assurance department, your surveyors and reviewers and most importantly your consultants to understand that a prior chart with additional information does exist.
A document that addresses OASIS Considerations for PPS has been linked under the Essential Links section in the sidebar to your left. As always, we welcome your comments or your emails at firstname.lastname@example.org.